Oral Answers to Questions

HOME DEPARTMENT

The Secretary of State was asked—

Police Community Support Officers

Lindsay Hoyle: How many police community support officers there are in Chorley; and if she will make a statement.

Jacqui Smith: There is now a neighbourhood policing team in every area in Lancashire. It is for the chief constable to decide where to deploy his police community support officers, but at the end of March 2007 the southern basic command unit, which includes Chorley, had 72 PCSOs—an invaluable addition to policing, with the primary focus of engaging with their local community.

Lindsay Hoyle: I thank my right hon. Friend for that answer. Can she confirm that the Government are actually providing 75 per cent. of the funding for PCSOs in Chorley? The leader of the council believes they are funded by the council, but it is the Government who provide 75 per cent. Will my right hon. Friend assure us that PCSOs will not replicate the police but will assist the police force, ensuring that police numbers remain the same?

Jacqui Smith: My hon. Friend is right: the introduction of PCSOs was an initiative brought about by the Labour Government. It was an initiative funded by the Labour Government to the tune of £7.6 million in the Lancashire police area this year. My hon. Friend is also right to note that we have increased the number of PCSOs at the same time as increasing the number of police officers. PCSOs play a complementary but different role.

Jessica Morden: What assessment she has made of the effectiveness of police community support officers.

Stephen Pound: What recent assessment she has made of the effectiveness of police community support officers; and if she will make a statement.

Jacqui Smith: Police community support officers make a very valuable contribution to the delivery of neighbourhood policing. That is why I am delighted to welcome the two-month intensive project being conducted by the National Policing Improvement Agency, which will build on good practice and establish greater standardisation where appropriate across forces on such issues as role and function, uniforms and equipment. It will also consider a new volunteer scheme for PCSOs, as Sir Ronnie Flanagan recommended. Ahead of that, I am pleased that the Association of Chief Police Officers shares my view that PCSOs should be at least 18 years old, and the Home Office will take forward work to introduce a code of practice to address that issue.

Jessica Morden: I welcome the announcement about the possibility of standard powers for PCSOs, who do an excellent job in my constituency and deserve the tools they need to do the job, but Unison and many PCSOs want all the powers currently on the statute book to be available to PCSOs—not just at the discretion of chief constables. Will my right hon. Friend keep the matter under review so that the public know what to expect from PCSOs, and that they have the full range of powers available to them?

Jacqui Smith: My hon. Friend makes an important point. As of 1 December, an agreed set of 20 powers will be standard across the whole country, thereby giving the public more certainty about the powers of PCSOs. It is to keep the matter under review and take that work forward that the National Policing Improvement Agency will carry out the two-month project I outlined, covering important points such as the standardisation of uniform and the issue of personal protection equipment.

Stephen Pound: I thank my right hon. Friend for her answer. Does she agree that those who demean and denigrate PCSOs not only insult a professional, hard-working, much valued body of men and women but demean many of our constituents who have come to see neighbourhood policing as one of the best, most reassuring and effective advances in policing since Dixon retired to Dock Green?

Jacqui Smith: As always, my hon. Friend's point is important and well made. Across the country, police community support officers play a hugely valuable role, making communities feel safer and promoting neighbourhood policing. That is why they are so widely welcomed by many of our constituents and the communities we represent. It is why, I suspect, they were welcomed even by the right hon. Member for Witney (Mr. Cameron) when he said in July last year:
	"I welcome the increase in police numbers...the deployment of community support officers...and the development of neighbourhood policing."
	Given that support in July 2006, I am hard pressed to understand why the Conservatives have now turned their back on the idea of further developing PCSOs.

Brian Binley: Mr. Speaker, like me, you will know that Dixon was killed in the last episode, so I hope that is not a factual interpretation.
	Northamptonshire police have reduced crime, partly due to the work of community support officers. Sadly, however, the Office for National Statistics massively understated population estimates for the county, creating yet another year of underfunding and forcing further cuts. Is the Secretary of State willing to do something about that unacceptable state of affairs, or do I have to tell the people of Northamptonshire that they will have to put up with another year of neglect under Labour?

Jacqui Smith: May I thank the hon. Gentleman for recognising the very important work of PCSOs in his community? I hope that everyone throughout the House supports that. He makes an important point about the funding made available to police services and the nature of the formula in recognising changes in population. We will in the near future of course be making announcements about next year's funding for police authorities and will bear in mind the issues that many forces have raised about the nature of population growth and how that is included in the formula. However, the increases that will follow the considerable increases to police forces will be possible only because of the investment that this Government have been willing to make in our police service. When the hon. Gentleman praises PCSOs in his constituency, I hope that he will also make clear his support for the extra investment made available by a Labour Government.

John Horam: Is the Home Secretary aware that, in the Metropolitan police area, there is an increasing problem with finding premises for PCSOs to operate from, because of the cuts in their budget by the Mayor? This has an impact on their effectiveness so will she look into it?

Jacqui Smith: It is obviously important that neighbourhood police teams have suitable premises from which to operate. I suspect that the challenge has been brought about by the considerable progress made by the Metropolitan police under the leadership of Commissioner Sir Ian Blair in delivering, two years ahead of target, neighbourhood policing teams in every single community in London.

Ashok Kumar: May I tell my right hon. Friend that PCSOs are doing a fantastic job in my area and especially in my constituency in working as part of neighbourhood policing teams? That has led to Crime falling by 2.5 per cent. between 2002 and 2007, so will she tell us what sort of financial support Cleveland police can expect so that we can keep on employing more PCSOs in the future?

Jacqui Smith: I cannot give my hon. Friend a figure today. As I said to the hon. Member for Northampton, South (Mr. Binley), we are looking very carefully at the way in which we distribute the increased support for policing next year and hope to make an announcement very soon. My hon. Friend is absolutely right to say that the important role of PCSOs at the heart of neighbourhood policing teams across the country is helping to ensure a continued reduction in crime and is helping to build community support, community engagement and confidence in the progress that we are making in crime fighting.

James Brokenshire: I am delighted that the Home Secretary has been forced to admit that allowing the employment of PCSOs under the age of 18 was a mistake, but what assurance can she give that, by potentially allowing PCSO responsibilities to be extended to detaining suspects and searching people who could be carrying dangerous items, she is not putting PCSOs and the public at greater risk? At least one PCSO has already been seriously injured when he was run down by a car earlier this month. With PCSOs receiving less training than fully qualified officers and police budgets coming under pressure, will this move not simply increase the number of such tragic incidents?

Jacqui Smith: We have introduced PCSOs and massively increased their numbers at the same time as increasing investment in our police forces and increasing the number of police officers. It is right that the Association of Chief Police Officers and the National Policing Improvement Agency, alongside the Home Office, now review the powers, the roles and the protection and training available to PCSOs in order to ensure that they can build on the very considerable contribution that they have made over the past four years. We are committed to doing that and to providing PCSOs with the training and protection that they need to carry out their job effectively.

Tom Levitt: I am sure that my right hon. Friend would like to know that I spent a day with three PCSOs in different parts of my constituency in the summer. Not only was it excellent to see the work that they are doing, but it was tremendous to see the reception that they received on the streets from shopkeepers and others. The biggest problem that we face with PCSO recruitment is that the officers are being used as a recruiting ground for the police themselves and we have to recruit PCSOs doubly quick to keep the numbers up. What my right hon. Friend said about funding was very welcome, and if she was saying that we will move towards full implementation of formula funding for the east midlands, that will be very welcome indeed.

Jacqui Smith: I know my hon. Friend and others in the east midlands have been making the case for funding in their area very strongly, including to my right hon. Friend the Minister for Security, Counter-Terrorism, Crime and Policing. As I have said previously, we will obviously look carefully at how we can distribute the police grant over the next three years, maintaining stability where necessary but ensuring that resources are focused on where they need to go. I agree with my hon. Friend that the really heartening thing about spending time with PCSOs—as I did in my constituency on Friday—is the number of people who know their names and who are willing to talk to them and to report to them things that are happening in the community, and the way in which they work not just with local people, but with other agencies to problem-solve, build confidence and help drive down crime and antisocial behaviour.

Custody (Police Stations)

Philip Davies: What assessment she has made of the efficiency of procedures for dealing with people being taken into custody in police stations.

Tony McNulty: The efficiency and effectiveness of police custody and custodial care remain under constant review within the police service. Others are equally involved, including the Independent Police Complaints Commission.

Philip Davies: During my time on the parliamentary police scheme, I spent two and a half hours waiting at the custody desk to book in a prisoner. A police officer said that waits of four hours were not uncommon. When supermarkets have queues at the checkouts, they open more tills until the queues have disappeared. What are the Government doing to ensure that extra capacity is being built into custody areas so that we can get police officers back on to the streets as soon as possible?

Tony McNulty: The hon. Gentleman makes a reasonable point and it is interesting to see that he has brought his supermarket skills and experience to the House. However, the issue is not simply about capacity; it is about a whole range of other factors, as I am sure his police force in West Yorkshire will have told him. Those other factors include what we do with the review of the Police and Criminal Evidence Act 1984, in terms of the whole process, and the level of civilianisation, or otherwise, inside custody suites. Many of the elements that are in place are there for a declared purpose. As Ronnie Flanagan said in his interim report:
	"There is undoubtedly a great deal of good and necessary bureaucracy within custody suites, much of it put in place to protect the vulnerable, to ensure due process of the law and to provide accountability for police actions."
	However, the hon. Gentleman's point about capacity at particular times is well made and I will take it back to all police forces.

Martin Salter: Does the Minister agree that it is about time we had a root-and-branch review of the Police and Criminal Evidence Act? In some cases, it offers a perverse incentive and discourages officers from making arrests due to the amount of bureaucracy that is necessitated when they arrive at the custody suite.

Tony McNulty: I have to disagree with my hon. Friend when he says it is about time that we had a root-and-branch review. We are nine months or so into the review that started last March. I agree that we need to get on with it and get to a stage where we know exactly what the parameters of PACE are. PACE has been around for a long time and there is popular consensus that it does what it is supposed to do—protect and look after the interests of those who encounter the police in the custody process. However, we need that review to report as soon as possible.

Elfyn Llwyd: I accept that the PACE forms are there for a purpose and are important evidentially. However, does the Minister agree that, in many other regards, police officers spend far too much time filling in forms pointlessly?

Tony McNulty: They do and have done in some cases, which is why we are looking at that in some detail. I have had a range of round-table and other meetings with a whole host of forces. However, the House should not run away with the notion that every single piece of paper a police officer is required to fill out comes from the centre. Often it is to do with local devices. Neither PACE nor bureaucracy goes to the import of the original question, which was that we need to look at, operationally and in other terms, getting people through the custody process, while their rights are protected, on an optimal basis.

David Taylor: I wonder whether the Minister would have a word with the Lord Chancellor to see whether he can get a grip on the number of people who are being decanted from the prison service into custody suites in police stations. According to senior figures in Leicestershire, that is becoming quite a substantial problem. Does the Minister anticipate that things will improve in the years to come? Even though Leicestershire is being reimbursed, it must be seriously inconvenient for the police to have to use their cells in that way.

Tony McNulty: I certainly can agree with my hon. Friend that things will improve, as he says, in the years to come. Operation Safeguard has been well executed by police forces throughout the country and it has not, to date and to my knowledge, impinged on the operational ability of the police forces involved.

David Ruffley: Last year, according to the Home Office's own figures, the amount of time that patrol officers spent on paperwork increased from 16.5 to 16.6 per cent., and the amount of time that patrol officers spent on patrol fell from 19.1 to 17.3 per cent. Is it not high time that the Home Secretary got a grip and cut red tape so that our police can get out there and spend more time catching more criminals?

Tony McNulty: Beyond the rather overblown hyperbole, the hon. Gentleman does, as ever, have half a point. There is broad consensus across the policing family and certainly in Government, and we are all actively working together to ensure that police are spending more time out on patrol. Rather as Ronnie Flanagan says about bureaucracy in his interim review, likening it to good and bad cholesterol, I would not want the House to run away with the notion that all paperwork is bad. Very often it is more than appropriate that there is a paper trail when the citizen encounters the police for whatever reason, good or ill. Is there too much? Does bureaucracy always have to be driven down so that our police can spend more time on the beat? Absolutely. Rather than being so shrill, perhaps the hon. Gentleman will work with us to ensure that that happens.

People Trafficking

Phyllis Starkey: What steps she is taking to reduce levels of trafficking of women for sexual exploitation.

Vernon Coaker: A comprehensive UK action plan on tackling human trafficking was published in March this year and sets out a range of measures designed to prevent human trafficking, protect and assist victims and investigate and prosecute the traffickers. The nationwide police operation Pentameter 2 was launched in October and focuses on the rescue of victims of trafficking for sexual exploitation while bringing to justice those involved in this serious criminal activity.

Phyllis Starkey: This is an issue which, as the Minister implied, affects every constituency. Just this week my local newspapers,  MK News and the  Milton Keynes Citizen, described
	"Thai ladies and new Japanese and Chinese girls weekly".
	It is difficult to see how any of those could be legally working in this country. Can the Minister reassure me that the Pentameter 2 operation will be following up adverts like that and checking whether there is evidence that vulnerable women are being trafficked and forced into prostitution?

Vernon Coaker: Pentameter 2 will indeed listen to any intelligence that comes forward about women or others who may be trafficked, including using such adverts to assist its work. My hon. Friend may be interested to know that those adverts are a concern. My right hon. and learned Friend the Leader of the House and I and others met the Newspaper Society, the Advertising Association and others to discuss the very issue that she raised—adverts in newspapers and magazines—to see what more can be done about it.

Anthony Steen: Will the Minister confirm that if the women who were discovered during a police raid, in which I was involved, on a sauna parlour in Hackney 10 days ago had been trafficked, they will be issued with a temporary residence permit, as he is obliged to do under the European convention on action against trafficking in human beings, which will come into force on 1 February next? Is he aware that if he issues them with that permit, they are much more likely to come forward to give evidence against their traffickers?

Vernon Coaker: The hon. Gentleman makes a good point. That is why, as he knows, we are looking to ratify the Council of Europe convention as soon as we can. To do that, we need to have in place all the various measures to ensure that we can legally meet the requirements of the convention. One of those requirements is that we have in place the various measures that he points out. He knows that when we ratify the convention, we will have to introduce temporary residence permits, periods of reflection and so on. We will do that as soon as we can. In the meantime, may I reassure the hon. Gentleman that, as he knows from the work that we do together on the issue, we will ensure that support is available for any victims of trafficking who are found through Pentameter 2-type operations or others?

Denis MacShane: The Minister kindly gave me a parliamentary reply showing that 16 men were convicted for trafficking last year and just 11 had been so far this year. Given that, according to Home Office estimates, 25,000 sex slaves currently work in the massage parlours and brothels of Britain, those conviction figures are derisory.
	Does the Minister agree that it may be time to look at the demand side? Frankly, too many dirty old, middle-aged and young men think that by putting down a few pounds they can abuse women, often under the age of 18, who are trafficked into our country and appear in adverts such as the ones in the local papers of my hon. Friend the Member for Milton Keynes, South-West (Dr. Starkey). This is not a sniggering or laughing matter, but a desperately evil aspect of modern slavery. The demand side needs to be tackled; the men should be named and shamed. If necessary, the law should be changed so that they are put in front of the courts.

Vernon Coaker: I do not think that anybody who listened to the remarks that my right hon. Friend has just made so powerfully and passionately would disagree with any of them. The whole House finds how such women are trafficked and used repugnant. The issue for us is what we do about it. My right hon. Friend points out that we need to consider the demand side, and the Government will consider what more we can do on that side of the equation. There have been 67 prosecutions since we passed the Sexual Offences Act 2003, which allows us to prosecute people who traffic women for sexual exploitation. We want that figure to rise and we are working with the Crown Prosecution Service to ensure that that happens.
	I say not only to my right hon. Friend but to the whole House that the issue is a real priority for the Government. We are considering what more can be done about it and will act as quickly as possible to take the matter forward.

Evan Harris: The Minister will be aware that the Joint Committee on Human Rights identified the very real need to treat the victims of sex trafficking as victims. He will be aware that on page 57 of the UK action plan, he accepted that although previously there had been prosecutions of victims for immigration offences, the Government no longer considered that it was in the public interest to do so. If that is the case, will he explain why proceedings are still hanging over two women—victims of trafficking—who are being assisted by the Poppy project? Will he have a word with the Attorney-General's office so that it is absolutely clear that the Government's policy is to treat victims as victims and not as criminals?

Vernon Coaker: It is absolutely the Government's position that victims of trafficking should be treated as victims, and we are trying to establish processes to make sure that that happens. As the hon. Gentleman will know, to ratify the Council of Europe convention one of the things that we have to do is to put in place measures and processes that allow us to identify victims and refer them to the appropriate support. We are in the process of doing that. As the hon. Gentleman mentioned, we do not wish to treat such people as immigration offenders. If he has concerns about any particular cases, perhaps he will write to me about them.

Kelvin Hopkins: In my constituency, there is a so-called massage parlour that my constituents tell me is simply a brothel; I am sure that there are similar establishments in many hon. Members' constituencies. There is no doubt that in that brothel young women are being exploited, possibly after having been trafficked from abroad. However, after months of being told, the police are still finding it difficult to close the place down. Is my hon. Friend absolutely sure that nothing more could be done to provide more powers and resources to the police to ensure that such places are closed down and that the women are rescued from their appalling circumstances?

Vernon Coaker: We know that there is more to be done on this issue. We do not want brothels continuing to operate in the way that my hon. Friend has mentioned. All I can say is that the Government are considering a whole range of measures, including on demand and on what more can be done about the establishments that my hon. Friend has just mentioned.

Damian Green: The Minister will know that his answer is disappointing on the specific point of ratifying the European convention against human trafficking. On 17 October, the Minister for Borders and Immigration said in a written answer to the right hon. Member for Rotherham (Mr. MacShane):
	"some amendments to primary/secondary legislation will be required"—[ Official Report, 17 October 2007; Vol. 464, c. 1108W.]
	The Minister has just agreed with that, so why has the legislation not been produced? Why are police officers like Chief Superintendent Paul Phillipson, the district commander in Peterborough, complaining that if they devote resources to clearing up the sex trade involving women trafficked from overseas, they get no credit from the Government because the Minister's Department does not make clearing up this type of crime one of the targets that it has to meet? Will he admit that this looks like another case of tough talk followed by a complete lack of effective action?

Vernon Coaker: The hon. Gentleman raises a very important issue. He should not underestimate the commitment of this Government—and of this Parliament, it seems to me—to ratify the Council of Europe convention. As many of his hon. Friends recognise, in order to make progress in this area in implementing the various processes that are necessary to ensure that we can ratify the treaty, we do not have to wait for ratification. We are taking this forward in terms of prevention, enforcement and all those matters, not waiting for the ratification process. At a time when people question the integrity and honesty of politicians, I do not want to recommend to my right hon. Friend the Home Secretary, or to the Prime Minister or to Parliament, that we should ratify the Council of Europe convention before I can honestly say that every single part of the necessary process is in place. As for whether we should get on with it, we are getting on with it.

Police Community Support Officers

Ben Chapman: What discussions she has had with the Secretary of State for Communities and Local Government on the effect of police community support officers on the regeneration of communities.

Meg Hillier: As we have heard, police community support officers have already had a positive impact in helping communities to work together, and we have plans to integrate neighbourhood policing and neighbourhood management. Only last week, I spoke to my right hon. Friend the Secretary of State and other colleagues about how to liaise with other Departments to improve the situation.

Ben Chapman: PCSOs have been very welcome in Wirral, South, where they have contributed a great deal to resolving problems, particularly those involving youths behaving badly. In my experience, they in no way merit the pejorative tags that have been attached to them by some parts of the press. However, they, like other parts of the network, find it difficult to solve the problem of displacement. What is the solution when effective police and partnership action results in badly behaving young people merely being moved from one area to another—for example, from Teehay lane in Bebington to Mayer park in Bebington?

Meg Hillier: My hon. Friend raises an important point. Clearly, moving a problem from one area to another does not solve it. The situation will be helped from April next year, when there will be a team in every area so that any displaced antisocial behaviour is picked up by the co-ordination of those teams. I already see that working to good effect in my own constituency, where we have a neighbourhood policing team in every ward. Sir Ronnie Flanagan's interim report recommends the integration of neighbourhood policing and neighbourhood management, and we are making progress on that. We also hope to work with local area agreements, crime reduction partnerships and disorder reduction partnerships to ensure that co-ordination on displacement takes place.

Nigel Evans: If anybody is attacking community support officers, they are not attacking the individuals who fill the jobs, who are doing a very good job under very difficult circumstances. However, it has to be recognised that they do not have the same training and powers as police officers. What can the Minister do to ensure that more people who are volunteering in this way can be taken into the full constabulary?

Meg Hillier: I am rather puzzled by the hon. Gentleman's comments. I will happily explain to him afterwards the exact role of police community support officers. They are not volunteers—they are paid officers trained to provide a different role to that of police constables. There are 16,000 PCSOs—had it not been for this Government, there would be none—in addition to the already expanded numbers of police.

Identity Cards (Foreign Nationals)

Adrian Bailey: What plans she has to introduce identity cards for foreign nationals resident in the UK.

Liam Byrne: Recent Royal Assent for the UK Borders Act 2007 will allow the Government to introduce compulsory identity cards for foreign nationals from 2008. We shall publish our strategy for this rollout very shortly.

Adrian Bailey: I thank my hon. Friend for his reply. What progress has been made in developing a biometric ID system, and what assessment has he made of its potential in combating illegal immigration?

Liam Byrne: The House will know that the Government are already deploying biometric systems in order to strengthen our border security. A system of biometric visas has been rolled out in about 117 countries around the world. Some time this week we will take our millionth biometric visa, and nearly 10,000 individuals have already been matched against existing watch lists that we hold, including lists with the fingerprints we have taken of those who have been deported. It is clear to me that biometric visas are already providing an extremely effective defence against illegal immigration and that they will be increasingly important in the future.

Patrick Mercer: I am interested in what the Minister said, but he knows that those who are resident in this country for three months or less will not be required to carry an identity card. A cursory understanding of the core al-Qaeda group makes it quite clear that its visits to countries such as ours will last a lot less than three months. Does that not drive a coach and horses through the whole concept of ID cards?

Liam Byrne: I disagree with that analysis. It was the former director general of the Security Service who said
	"widespread use of false documents is an essential aspect of terrorist activities. Al-Qaeda's own training manual requires its operatives to acquire false identities to hide their terrorist activities."
	The only countries in Europe other than the UK that do not have identity cards in place, or which are not introducing them, are Ireland and Denmark, and even Denmark has a national civil register. Our concern is to multiply the tools to fight terrorism that we have at our disposal, but the important point raised by my hon. Friend the Member for West Bromwich, West (Mr. Bailey) is the need for ID cards to allow us to come downharder on illegal immigration. That is why last week we introduced tougher penalties for businesses that employ people illegally, and as we increase the penalties for breaking the rules, we need to make businesses' job easier. Biometric ID cards for foreign nationals will help with that.

John Redwood: These illegal immigrants are here only because our border control failed in the first instance. Why does the Minister not strengthen the surveillance of passports and visas when people first apply for entry into the country, and ensure that people we do not wish to see here, or those who are a threat to this country, are not admitted in the first place?

Liam Byrne: I hope that the right hon. Gentleman will forgive me for saying that that is a slightly 20th-century way of looking at border control. If we are to have adequate defences against illegal immigration in the future, we need to strengthen our checks abroad. That is why biometric visas are preventing would-be illegal immigrants from coming to this country before they get on a train, plane or boat for the UK. We have to secure our borders in the UK even further, which is why we are introducing a single border force.
	I do not think that we will make real headway against illegal immigration until we stop the cause of it, which is illegal working. That is why we have to increase the penalties for businesses that break the rules. It is also why we have to make it easier for businesses to know whether a foreign national is who they say they are, and whether they have the right to work. That is where ID cards will help.

Metropolitan Police Service Targets

Tom Brake: What recent discussions she has had with the Metropolitan Police Service on police targets.

Tony McNulty: Ministers regularly meet the commissioner of the Metropolitan Police Service and other MPS officers and officials to discuss a range of matters, including police targets.

Tom Brake: Is the Minister aware that in London the police are working to two contradictory crime reduction targets: one set by the Home Office, and the other set by the Metropolitan Police Service? Why is that, and when will the police start working to just one crime reduction target?

Tony McNulty: If the hon. Gentleman seeks to illuminate me about the contradictory targets, I shall look into the matter. As far as I am aware, there is no such contradiction in targets. The Metropolitan police's overall contribution to the public service agreement target to reduce crime by 15 per cent. stands. How they achieve that contribution is a matter for that service, just as it is for all other 42 police services.

Barry Gardiner: On 19 October, my constituent, Mr. Alan Angel, was held up in his own home in Northwick Circle, Kenton by three youths armed with a firearm. I want to stress that Mr. Angel has thanked the police for their subsequent actions and response, and for the support that they have given. However, Mr. Angel found out that they were unable to access the CCTV footage from the station to which the three had fled until the Monday morning. Would my right hon. Friend check what protocols and targets are in place for the downloading of footage between London Transport police and the Metropolitan police?

Tony McNulty: My hon. Friend raises a serious point, which I will look into. I can assure him that no national protocol or target restricts or limits in any way the operational efficiency of the police in disc-dumping CCTV footage. I am happy to meet my hon. Friend and the Brent borough commander, if we need to, to discuss the matter further.

Justine Greening: May I ask the Minister about the overall budgeted target work force for London? My local borough commander tells me that we are 700 officers below that target work force across London. Does the Minister really expect the Metropolitan police to hit their targets when they have not the targeted people to do so?

Tony McNulty: As I have said in written responses, many of those comparisons relate to pre-1997 figures. They cannot be compared—they are like apples and oranges. It is a matter of fact that the resources currently afforded to the Metropolitan police, whether for neighbourhood policing or any other aspects, are at absolute record high levels, as can be seen though their achievement of targets and the reduction of crime throughout London.

Crime Statistics

Roberta Blackman-Woods: If she will ensure that crime statistics are compiled at constituency and ward level.

Vernon Coaker: The Government have committed to making consistent monthly local information on crime available throughout the country. My starting point is that the information should be available at ward level and more locally where possible, subject to constraints around data availability. The Home Office is working with the Association of Chief Police Officers, the Association of Police Authorities and other stakeholders to identify how that can be achieved.

Roberta Blackman-Woods: I thank my hon. Friend for that response. Does he agree that if crime statistics were more widely used and available at neighbourhood level it would help us to address the fear of crime in constituencies such as mine? In Durham, overall crime rates are low and falling, but the public are not necessary fully aware of that.

Vernon Coaker: I agree totally with my hon. Friend. That is one of the reasons why the Home Secretary announced that by July 2008 we want local crime statistics to be available to local areas—at ward level, if possible—so that local people can make sense of what is happening in their areas with respect to acquisitive and violent crime. When people see those matters locally, the figures obviously become much more real to them than the national statistics. As my hon. Friend says, if people see the local figures, public confidence will rise and people will know more properly what is going on with policing in their area.

Citizenship

Mark Pritchard: If she will make it her policy to include in citizenship ceremonies a statement including a list of acts of treason and high crimes against the state.

Meg Hillier: Citizenship ceremonies for new British citizens are intended to be celebratory events where new citizens are welcomed into their local communities and to Britain. Those applying for citizenship are informed at the point of application and in their declaration that it can be withdrawn if they engage in conduct that is prejudicial to the public good.

Mark Pritchard: I am grateful to the Minister for that response. Does she agree that in those ceremonies there should be an underlining of the responsibilities to this nation of those who become British citizens as well as of their rights under this nation? If she does agree, would she consider amending legislation so that those naturalised British citizens who commit high crimes against this country and the state, or, indeed, treason, should have their citizenship revoked on conviction?

Meg Hillier: My right hon. Friend the Home Secretary already has powers to do just that. The Government can withdraw citizenship from the people in the category outlined by the hon. Gentleman for a range of issues. I am happy to write to him about that, but those issues include war crimes, other serious offences, public order offences and conduct prejudicial to vital national interests, including treason. We are also conducting several bits of work across Government, including the citizenship review. I would be happy to share with the hon. Gentleman the information that citizens receive. His comments on that information would be much welcomed.

Gisela Stuart: I welcome the citizenship ceremonies, which are moving events, and I wish that they had existed when I became a British citizen. Has my hon. Friend considered writing to local authorities to suggest that they invite their Members of Parliament to some of the ceremonies? Hon. Members should be aware of their significance.

Meg Hillier: I recently met local authority officers who are responsible for organising citizenship ceremonies. Several local authorities conduct interesting ceremonies—for example, Brent has held some at Wembley stadium. Oxfordshire has an interesting programme involving schools, linking GCSE classes on citizenship. Several authorities invite their Members of Parliament. If my hon. Friend contacts her local authority, I am sure that it would be willing to extend an invitation to her.

Topical Questions

John Baron: If she will make a statement on her departmental responsibilities.

Jacqui Smith: One of the key responsibilities of my Department is ensuring that we secure the benefits of migration, which supports economic growth, to the UK, while protecting our borders and managing the impact of migration on local communities. For that reason, we published on Thursday key parts of our strategy on illegal working. We have listened to employers and others in shaping our approach. Having done that, we will implement a new system of civil penalties and a tough new criminal offence for those who knowingly employ illegal workers. I have proposed that the maximum civil penalty should be £10,000 per illegal worker. To complement that, we will take steps to raise employers' awareness of the changes through national press advertising and an improved service to support employers in verifying the immigration status of prospective employees. Those measures will complement our other initiatives to control immigration effectively, especially the new unified UK border agency, which the Prime Minister announced on 14 November, and the points-based system, which will be launched early next year.

John Baron: Now that the Director of Public Prosecutions and the former Attorney-General have expressed serious doubts about the need to extend the pre-charge detention period beyond 28 days, and given that countries such as Russia, France, Turkey and even the United States have detention periods of less than eight days, will the Home Secretary either renounce her ambitions for 56 days or give the Chamber one concrete example of the police taking 56 days between arresting a terrorist suspect and finding the evidence to bring charges?

Jacqui Smith: As I made clear to the Select Committee on Home Affairs, the Government do not argue that there is a current case in which detention beyond 28 days has been necessary to charge. Thank goodness for that, otherwise I would rightly be explaining to the Chamber why the Government had not legislated to prevent the release of potential terrorists. However, it is clear from the Metropolitan Police Commissioner, from Ken Jones, president of the Association of Chief Police Officers, from Deputy Assistant Commissioner Peter Clarke in  The Daily Telegraph today and from the Home Affairs Committee in a report last June, that a wide range of people believe that it is possible, if not likely, in the near future that more than 28 days might be needed to undertake the necessary investigations to charge somebody. It is responsible, proportionate and precautionary to legislate now for that eventuality rather than risking this country's security by allowing people out who could have been brought to justice.

Keith Vaz: Given last week's events involving the Treasury and the Inland Revenue and the use of data, is the Home Secretary satisfied that the necessary protection is in place for any data that would be gathered under the identity card scheme? Is she planning to review that arrangement in view of what happened last week?

Liam Byrne: The House will know that, where there are lessons to be learned from last week's events at HMRC, it is right that we learn them. That is why the Prime Minister has asked PricewaterhouseCoopers for an independent review of the matter, the Cabinet Secretary is examining data security in all Departments and the Information Commissioner will be given power to spot-check Departments' compliance with the regulations.
	However, it is also right to ask whether parliamentary oversight of the scheme can be strengthened. The House is the guarantor of our liberties, which include the right to privacy. Hon. Members know that, under the Identity Cards Act 2006, a national identity commissioner will be appointed to oversee the national identity register, reporting annually to Parliament. There is an important question to be asked about who will watch the watchman—or watchwoman—and now is the time to start reviewing the way in which Parliament can play a stronger role in providing such oversight in future.

Tom Brake: What assessment has the Department made of the relative effectiveness in reducing gun and knife crime of compulsory ID cards versus fully trained police officers?

Jacqui Smith: We have of course taken a range of actions to reduce gun and knife crime, including ensuring that there are more police officers on our streets, increasing enforcement activity and introducing stronger sentences for both types of crime, with a minimum sentence for the possession of guns of five years and an increase in the maximum sentence for the possession of knives. However, it is also an important contribution to public protection to ensure that we can be clear about the identity of those who, for example, are arrested and that we can be clear, with the aim of public protection, that the identity that somebody expresses to the authorities is actually theirs. It is through the use of biometric ID management that we can be more confident that that will be the case, but that does not come at the expense of the wide range of other actions that the Government have taken to help to counter gun and knife crime.

Russell Brown: My right hon. and hon. Friends will be aware that yesterday was the UN international day for the eradication of violence against women. Can the Minister give the House an indication of what genuinely positive role men can play in tackling that behaviour, which destroys so many families?

Vernon Coaker: I thank my hon. Friend for pointing out that yesterday was the UN international day for the eradication of violence against women, with which the white ribbon campaign is associated, as he will know. Today I had the privilege of being at City Hall for the launch of the Men's Coalition, an organisation that tries to bring together men on a variety of issues, but particularly on domestic violence. Domestic violence is not, fairly obviously, just an issue for women. The vast of majority of men are not violent, but the vast majority of the perpetrators of domestic violence are men. The Men's Coalition calls on men to speak out about the issue, so that we can all join together to do as much as we can to end this heinous crime, which so often takes place behind closed doors, without anyone knowing about it.

David Davis: May I ask the Home Secretary about the subject of identity cards? If the Government give away someone's bank account details, that is a disaster, but at least they can change their bank account. What, precisely, does someone do if the Government give away their biometric details?

Jacqui Smith: There is of course an important protection in an identity card system, through the use of biometrics. Biometrics will link a person securely and reliably to his or her unique identity. It will therefore become much more difficult for people to misuse other people's identity, even if full details of their biographical information are already known. The current plan for the national identity register is for biometric information to be held separately from biographical information, thereby safeguarding against the sort of eventuality that the right hon. Gentleman described.

David Davis: I do not look forward to the day when the National Audit Office or anybody else asks for that information and is sent it. Let us look at the other aspect of identity cards: the question of protection. The Home Office is currently prototyping a European-wide identity card project called Project Stork. How will it prevent a repetition of the disaster of the past few weeks when sensitive personal data are held not by one Government but by 27?

Jacqui Smith: If the right hon. Gentleman wants to give me more information about the particular allegation that he is making, I will of course be willing to follow it up, but the point that I made remains. The advantage of a national identity register is that it enables the linking of biometric information, maintained on one database, with biographic data, maintained on another, thereby strengthening the protection for individuals in circumstances where, for example, biographic data were stolen or went missing. That is a strengthening of the current position, which is why any Government or Opposition who are serious about public protection and identity fraud should be thinking seriously about how we address those issues, instead of making hay.

John Heppell: I welcome the Home Secretary's announcement that we are to crack down further on illegal working in the United Kingdom. I accept that there is no excuse for illegal working or undercutting wages in any circumstances. Does my right hon. Friend agree that, when employers knowingly—I stress, knowingly—hire illegal workers, there should be even tougher penalties, including unlimited fines and imprisonment?

Jacqui Smith: My hon. Friend makes an important point. An important part of the announcement that we made last Thursday was that we should take a more fast-track approach to employers who have employed illegal workers, perhaps through negligence or through not carrying out proper checks. Such activity is serious, and should involve a civil penalty, but we would also support the ability of those employers to check the status of their workers. There should, however, be a different scale of offence for those employers who knowingly employ illegal immigrants, often for their own personal profit and to the detriment of the welfare of the people they are employing. My hon. Friend is absolutely right to say that there should be the potential for a prison sentence in those cases, and there will be the potential for a prison sentence of up to two years and an unlimited fine in those circumstances.

Nicholas Clegg: Last Tuesday, we learned from Home Office figures that the number of failed asylum seekers who have been deported now stands at its lowest level in five years. That comes on top of figures showing that successful appeals against an initial refusal are as high as 40 per cent. for asylum applicants from some countries. Does the Minister not agree that the system is inefficient and inhumane, and that it is now time to take the radical option, as in Canada, of establishing a fully independent asylum applications system? The system in Canada has a rate of successful appeals following refusal as low as 1 per cent.

Liam Byrne: On behalf of Labour Members, I welcome the hon. Gentleman back to the Chamber following his absence. He has been much missed. As he will know, my objection to his proposals relates to the fact that I am extremely concerned about the pattern of behaviour demonstrated by his party on tackling illegal immigration. First, there was his party's decision in Committee to vote against an extra £100 million for immigration policing. Then, there was its proposal to extend an amnesty to certain people, some of whom would have claimed asylum. That is a policy that—

Mr. Speaker: Order. We are not going to use up this time talking about Liberal party policy. I call David Winnick.

David Winnick: As the Government are clearly in favour of good community and race relations, will my hon. Friend the Minister and the Home Secretary deplore the fact that notorious Nazi sympathisers and racists are being given a platform tonight by the Oxford Union? Should not all the political parties in the House condemn that, as anti-fascist organisations and Jewish and Muslim groups have done? The Oxford Union should know better than to provide a platform for these hooligans.

Jacqui Smith: I thoroughly deplore the sentiments, the expressed views and the actions of both the gentlemen who are due to speak at the Oxford Union this evening. There is already legislation in place, which I hope will be used wherever they speak if they overstep the mark. The Oxford Union is a debating society, and I know that some hon. Members have now, correctly and with dignity, resigned their membership of it. I am pleased to say that, during the three years that I was at Oxford university, I never even attended the Oxford Union, partly because it was simply a debating society. It is up to the society to make its own decisions, but I completely deplore the views and attitudes of those who will be speaking in that debate.

John Randall: When my right hon. Friend the Member for Haltemprice and Howden (David Davis) asked the Home Secretary about a scheme, it seemed that she was not aware of it. Can she confirm whether she is aware of the scheme that he was talking about?

Jacqui Smith: I outlined all the details and safeguards already proposed for the national immigration register, including the fact that biographical information will be kept separately from biometric information, and the Minister for Borders and Immigration has already outlined our suggestion that we should look even further into the relevant safeguards. However, Conservative Members should think very carefully if they are challenging us on the need for public protection—particularly for increased protection in respect of illegal immigration and counter-terror—while at the same time proposing the withdrawal of an important method through which we will be able to safeguard people's identities as well as tackle terrorism and illegal immigration. That is the serious issue here.

Adam Holloway: The Minister for Borders and Immigration said that migration is bringing new wealth, but also new worries, to Britain. How will the points-based system with no upper limit address those worries?

Liam Byrne: The points system will cover a much greater proportion of the inflow of newcomers to this country than the hon. Gentleman's party's proposal, which would limit a cap on economic migrants from outside the EU. The important point is that when setting the balance in the points system we must not only listen to the needs of the business community—we know that migration is worth £6 billion to our economy—but look at the wider impact of migration on British public life. It is only by weighing the two that we will achieve the right net balance in migration policy for this country. On that, I believe that there is a degree of consensus between us.

Barry Sheerman: Is my hon. Friend aware of increasing evidence of groups of men in most of our towns and cities—certainly in Yorkshire and probably beyond—who are actively targeting girls as young as 12, 13 and 14 in order to exploit them sexually and get them into prostitution? Is he further aware that when these cases come to the fore, very little leadership comes from the police?

Vernon Coaker: I thank my hon. Friend for that reply— [Interruption.] We are aware of those sorts of crimes and there have already been one or two police operations with respect to them. Indeed, Operation Pentameter II, the new police operation tackling the trafficking and sexual exploitation of young girls—either internally or from abroad—is highly aware of my hon. Friend's point. It is working hard with local police forces to ensure that when the operation is finished police forces across the country will have that aspect of policing as part of their core business.

Welfare and Skills

John Denham: With permission, Mr. Speaker, I will make a statement about the reform of welfare and skills.
	Since 1997, the Government have transformed work: 29.2 million people are in work—2.8 million more than in 1997—1 million fewer people are on out-of-work benefits, and increased prosperity has been felt in every region and every nation in the UK. But the world continues to change, and we must change, too. In an increasingly globalised and competitive world, we must use to the full the skills, talents and aspirations of all our people. As my right hon. Friend the Prime Minister said this morning, Britain's economy of the future will have 5 million fewer unskilled jobs than today, so to succeed as a country, we must raise our skill levels as never before.
	The global changes threaten those who are least well equipped to respond. Those with low skills will find it harder to find work. Even today, it is estimated that 15 per cent. of claimants have basic skills needs and 50 per cent. have qualification levels below level 2. They and their families struggle to share in the increasing prosperity of Britain.
	That is why, today, together with my right hon. Friend the Secretary of State for Work and Pensions, I have published "Opportunity, Employment and Progression: making skills work". It sets out how we are transforming welfare by putting skills at the heart of the system. As my right hon. Friend the Prime Minister said this morning:
	"If in the old days lack of jobs demanded priority action, in the new world it is lack of skills."
	We will change the benefits, skills and employment system. When people sign on for benefits, they should sign up for skills. We will make it easier for those on benefits to gain new skills. We will provide the tailored support that people need in order to get into work, and we will provide new opportunities for people to train. We intend to introduce legislation to give legal rights to train, but with those rights come responsibilities—responsibilities to upskill and to work.
	Obtaining work, however, is just the start. We will also help people to get on in work by helping them to progress. We will create an advancement and careers service to help people overcome the barriers to moving from welfare to work and beyond. As my right hon. Friend the Secretary of State for Work and Pensions has announced, all new jobseeker's allowance claimants will be given a more rigorous skills check to identify those who need basic numeracy, literacy and English language training or support. All new claimants will be able to use the new advancement and careers service to undertake a comprehensive skills health check. For those who are out of work for six months, we will make skills health checks mandatory, at the discretion of Jobcentre Plus advisers.
	Where the need for raised skills is firmly identified, we will pilot giving Jobcentre Plus personal advisers enhanced powers to mandate training, and to offer training allowances of up to eight weeks' full-time study when it is clearly designed to meet employers' needs. For lone parents on income support we will extend the employment retention and advancement pilot nationally, providing in-work advisory support and discretionary emergency hardship grants of up to £300. We are also rolling out a weekly work credit of £40, or £60 in London. All lone parents will receive a skills screening at the start of their claims, and we aim to ensure that all of them can undertake a skills health check. We will offer such a check to lone parents two years before they are due to return to work, and will consider making it mandatory.
	For those on incapacity benefit, the housing benefit rules will be changed to abolish the 16-hour rule which limits the hours of study for those on the short-term rate. Long-term benefit claimants moving into work will see an increase in income of at least £25 per week, allowing for reasonable transport costs.
	As we change the welfare system, we will also improve opportunities to train. In setting the Learning and Skills Council budget for the next three years, I recently announced improved opportunities for training at every level. We will invest £1.5 billion a year in basic skills for life and pre-level 2 training. We will increase the number of training places at level 2 to 800,000 by the end of the next three years, and will increase the number of level 3 places by 148 per cent. by three years from now. We have set aside enough funds—subject to the availability of high-quality employer places—to increase the number of apprenticeships in England from 250,000 to 400,000.
	However, we need to do more to ensure that the training opportunities are available to those who need them most. My right hon. Friend and I will ensure that Jobcentre Plus, colleges and training providers work more closely together. Tomorrow my right hon. Friend will give more details of how Jobcentre Plus services are to be commissioned in future, but I can say today that there is a joint commitment to greater convergence with LSC funding, and that we will jointly explore the scope for progressively joining up processes to underpin the integration of employment and skills services.
	For many people, the transition from a low-paid to a better-paid job can be as hard as moving from benefit to work. We will ensure that the advancement and careers service works closely with Jobcentre Plus, training providers and other voluntary and statutory agencies to provide skills screening, skills health checks and access to advice on overcoming all the obstacles to progression, including child care, housing, transport and in-work benefits. I can announce today that I have allocated £2 million to test 10 prototypes in 10 areas next year.
	The advancement and careers service will provide full skills health checks for half a million work seekers and half a million people in work per year by 2010-11. I can also confirm that we will pilot skills accounts from next year. We want learners with skills accounts to have access to £500 million of funding by 2010-11, and to nearly £1.5 billion by 2015.
	Through local employer partnerships, more than 200 companies have committed to offer jobs to people who are out of work, helping towards meeting our target of 250,000. The Learning and Skills Council, colleges and training providers will work closely with Jobcentre Plus and employers to ensure that individuals receive both pre-employment and in-work training. High-quality in-house training is provided by many companies involved in the LEPs, and I have asked for the accreditation of in-house employer schemes to be fast-tracked, and expect the first schemes to be accredited by Christmas.
	This country can deliver the opportunities to work and to gain better skills only through the closest possible partnership with employers. That is why we are making the training system more responsive and flexible to meet the needs of employers. Fifty-two thousand employers have taken advantage of "train to gain" with more than 100,000 learners gaining new qualifications. Today I can confirm that the budget for "train to gain" will rise to more than £1 billion by 2010-11—about one third of the adult training budget. Colleges that are successful in meeting employers' needs will be able to expand the volume of training they provide, and the bureaucracy of taking part in "train to gain" will be reduced.
	We will allocate £90 million to enable 60,000 small and medium-sized businesses to identify how skills training would grow their business and profitability. We will extend "train to gain" to cover volunteers, the self-employed and offenders who have secured employment prior to their release. We will ensure that there is a further education system that provides specialist vocational excellence in key areas of teaching and learning, both at national level—through national skills academies—and at regional and local levels. "Train to gain" brokerage will be extended to larger companies.
	Our reforms to put skills at the heart of welfare will help to drive Britain's economy forward to compete in an increasingly competitive world. By giving people new rights and responsibilities, we will unlock the talent and aspirations of all our people to ensure that no one gets left behind. These reforms are fundamental to creating a stronger, fairer and more prosperous society. I commend the paper to the House.

David Willetts: Nobody on the Opposition side of the House would quarrel with the Government's objective of having a more skilled work force, or the importance of tackling the barriers that stop unemployed people getting into work, but in order to make real progress in tackling those problems the Secretary of State would have had to confront uncomfortable evidence that would have explained that after 10 years of initiatives many of the Government's policies are still not working. In particular, why is it that after 10 years the number of young people aged 16 to 24 who are not in education, employment or training—the so-called NEETs—has increased from 1,082,000 to 1,260,000? The Secretary of State should have confronted that uncomfortable evidence, so as to do better in the future.
	The Opposition agree on the importance of linking jobcentres and skills. That link desperately needs to be made, and we want it to work. Again however, for it to work the Government need to learn lessons from what has not worked so far. In particular, if the only skills training that is going to be available at jobcentres is accredited training leading to LSC-approved qualifications —which is how so much of the funding is currently disbursed—is there not a real danger that some of the most worthwhile programmes will suffer from not being accessible to unemployed people? This morning, I visited City Lit—probably the country's largest adult education college, and an excellent institution which I know that the Secretary of State has visited—where I was told that many of its most worthwhile courses that help people out of unemployment and into work were suffering from cuts in LSC funding, because they did not provide accredited qualifications of which the LSC approved. If the Secretary of State is going to use this joint working simply to push people into accredited qualifications, is there not a danger that he will miss out many of the courses that people really need?
	I also have some questions about the programmes that the Secretary of State has announced. He has announced that £1.5 billion a year will be invested in basic "skills for life" and pre-level 2 training. He has announced that we will increase the number of training places at level 2 to 800,000. However, are these not courses that plug the gaps that should have been filled at school? They are teaching people the basics of reading, writing and arithmetic—giving people the basic equivalents of GCSEs. The Secretary of State began by saying that this was part of his new vision of a highly skilled work force competing in a competitive global economy. Now, what he is really announcing is extra places to plug the gaps in a school system that should be doing better.
	I accept that not all those people left school under Mr. Blair. Some will have left school under Margaret Thatcher and John Major, and quite a few probably left under Harold Wilson and Jim Callaghan. However, the Secretary of State cannot pretend that such a programme is in any way rising to the challenge of providing skills for the 21st-century economy.
	The Secretary of State also talked about apprenticeships, but let us be clear about what he is pledging. He is now talking of a target of 400,000 apprenticeships, up from 250,000 today. Will he confirm that back in 2002, the then Chancellor—now the Prime Minister—promised 300,000 apprenticeships by 2004? Will he confirm that then, in April 2003, the then Chancellor promised 320,000 apprenticeships by 2006? Will he confirm that as recently as this year's Budget, in March, the then Chancellor promised to double apprenticeship numbers to 500,000? So what we have here is a record of successive retreats from ambitious commitments and pledges because of a failure to deliver them. Will the Secretary of State also confirm that the number of apprenticeships that we recognise as apprenticeships—genuine technical qualifications sponsored by employers, which are now called advanced apprenticeships—have been in steady decline under this Government, and have now fallen below 200,000?
	Finally, I congratulate the Secretary of State on something that is enormously to his credit—on not using at any point in his statement today that British National party slogan, "British jobs for British workers". The Opposition congratulate him on his self-restraint. Long may it continue.

John Denham: I am grateful for the warm welcome that the hon. Gentleman has given the statement—but unfortunately I have to point out to him that he is in error on almost everything that he said. Let us take for a start the claim that the figure for young people not in education, employment or training shows a fundamental failure in the system. The first thing that we must understand is that there has been a massive fall in the long-term youth unemployment that characterised the experience of so many young people under the Conservative Government. Secondly, there has not been a significant change in the proportion of that cohort who are not in education, employment or training compared with the period when the Tories were in power; however, there have been very significant shifts in what it represents. It represents not only far less long-term youth unemployment but the massive increase in the number of students taking gap years from university, who are not distinguished in the figures.
	There is a real issue here. There has been some increase in the number of under-25s claiming incapacity benefit, which is one reason why my right hon. Friend the Secretary of State for Work and Pensions, as part of his statement earlier today, indicated that pathways to work—the very successful programme that has begun to reduce the number of people on incapacity benefit—will not only be extended nationally to new claimants but will for the first time be targeted at existing claimants, starting with the under-25s. So where there is a problem, we are determined to address it.
	On training, the hon. Gentleman and I are simply going to have to disagree. There are a range of measures, budgeted for, for the Learning and Skills Council and Jobcentre Plus that are intended to ensure that individuals gain the early skills that they require to get into work, and that they can continue to get recognised qualifications when in work. Those courses—whether they are delivered by the employability skills programme that started in August, which focuses on getting people into work, or by the pre-level 2 programmes—are designed to achieve the two things that individuals want: sufficient capacity to get a job in the first place, and the qualifications and skills that mean that they remain in work and do not go back on to benefit. Our programmes are chosen with those aims consistently in mind. We have stripped out the programmes that have proved not to be effective for the individuals concerned.
	As for the £1.5 billion to plug the gap, the hon. Gentleman had enough intellectual honesty to abandon his argument halfway through. We could spend all afternoon agreeing that Mrs. Thatcher's Government were a terrible Government. A moment's thought will tell us that the vast majority of those in the work force did not leave school under this Government—and certainly did not complete the greater part of their schooling under this Government. That does not really matter, though, because some of them did, and the point about these policies is that we cannot write people off. There must be a second or even a third chance for people who missed out first time round—and I would extend that to the diminishing number of young people for whom that would be true under this Government. This is the right thing to do.
	On apprenticeships, the hon. Gentleman's research is simply wrong. He has—inadvertently, I am sure—confused figures that my right hon. Friend the Prime Minister used when talking about the UK as a whole with the figures that I have been using for England. The significance of my announcement is that the target for 2020 was for 500,000 apprenticeships for the UK as a whole and 400,000 for England. With the funding that we have set aside, and if we can secure the proper, quality employer places, we can achieve the 2020 target about eight years early. That would be good for the economy and enormously good for young people who are seeking work in this country.

Kali Mountford: I congratulate my right hon. Friend the Secretary of State on his visionary statement. Although I agree that many people need help because they did not have the advantage that young people have today of having literacy and numeracy skills set before them, some who did have such chances now need to gain new skills because they have ill health and have to change to a different job. Will my right hon. Friend explain to the House more fully how people whose old skills are no use to them any more, and who need a new chance, can, with the help of their employer and perhaps their trade union, train for something else?

John Denham: My hon. Friend raises an important issue, and I shall just mention two things. First, I pay tribute to the work of the 18,000 union learning representatives. We estimate that they have encouraged about 250,000 fellow employees back into work over the past couple of years since the scheme has been running. Someone's best friend at work will often be the most likely person to convince them that they should have another go at training, and the union learning representatives have been a success.
	Secondly, and importantly, I come to something that was part of our review of "train to gain". In the first year of the programme, it was not possible to use "train to gain" to provide a subsidised place for someone who already had a level 2 qualification. We are now saying that where an employer is using "train to gain" we will not discriminate in that way between those of their employees who have a first level 2 qualification and those who do not. That will free up the system enormously for precisely the sort of person that my hon. Friend has in mind.

Sarah Teather: I thank the Secretary of State for providing an advance copy of the statement, and there is much to be welcomed in it. The joined-up approach is common sense, and I welcome the change in respect of the 16-hour rule for benefit and study. We have requested that for a long time. We might question why the long-term unemployed and those who are workless were not receiving a skills audit as a matter of course, because most people would have expected that to have been happening anyway. It is worth reminding everyone that the number of people who are long-term sick is more or less the same as it was when this Government came to power in 1997.
	I have some questions about the Secretary of State's statement. Does he envisage the advancement and careers service to be the same as the universal adult careers service that he announced in the summer? If it is not the same, how were they linked together? If it is the same, has he learned the lessons from the Connexions service? Although Connexions improved the service for many young people from socially excluded groups, we found that a decline in access occurred for people who wanted simpler and more straightforward advice.
	There are three obvious elements that a careers service needs to work. The first is personalisation, the second quality and the third independence. Personalisation is obviously key, and I wonder whether the Secretary of State has learnt the lessons from the new deal, in which many young people were pushed on to generic programmes, rather than on to specific courses that addressed their personal issues. Does he envisage some sort of triage system, which could provide signposted advice to people who may require advice on medical issues or child care? How would that link with the careers service?
	Often, the issues with access to training and work are about confidence, and many people do not have the self-confidence to go on a full accredited course. It would be a shame if the Government ruled out the option of unaccredited courses, in areas such as leisure, which they often pooh-pooh. For many people, those are the only route back into learning.
	On quality, how will the proposals be linked with the closure of Jobcentre Plus offices, especially in rural areas? Does the Secretary of State really think that Jobcentre Plus is the ideal vehicle for providing an expert careers service, and will he invest sufficient money to bring it up to standard? The Connexions service provides services to 2 million young people and costs £500 million. If we extend that to all the workless, it would cost some £2 billion. Does he envisage that level of investment to provide a high-quality service?
	On independence, what involvement does the Secretary of State envisage for the voluntary sector, and what role will local authorities play? The Lyons review, for example, foresaw a role in place shaping, and that would appear to be a good example of how local authorities could play a role in training.
	For many people, it is a big jump to a full accredited course. The people who are finding it difficult to stay in the job market are the very ones who will find it difficult to stay on a full course. When will the Government make proposals for a credit-based or unitised approach to level 2 and level 3 accredited learning? That is vital to ensure that people who begin training can reap the benefits of what they have already undertaken.
	The Secretary of State has announced £1 billion for the "train to gain" programme—but what proportion of that money will go to the broker system, rather than to training?

John Denham: I congratulate the hon. Lady on a considered and intelligent response to the issues I raised this afternoon. The figures that I have for incapacity benefit suggest that the numbers claiming it have fallen since 2003 by 120,000, which is due in no small measure to the success of the pathways to work programme, which is why it is now being extended across the country and targeted at young people under 25. It is worth remembering that had the trends continued as they had become well established in 1997 under the previous Government, some 4 million people would be on incapacity benefit by now. This Government had to turn round the supertanker and get it going in the right direction.
	The hon. Lady asked about the advancement and careers service, and it does refer to the same concept. My view was that the idea of a careers service sounded much narrower than the practical support that many people want, which will also address child care support, disability access issues and housing issues, all of which may be as significant an obstacle for an individual as the obtaining of a qualification.
	The hon. Lady raised some good questions about the design. As I said in the statement, I want to see about 10 prototypes across the country, because I do not want to prescribe the approach from the centre. We will need to link up Jobcentre Plus with colleges—but different areas have different patterns of local voluntary sector advice services, for example. I hope that local authorities will make various proposals for the best way to achieve an integrated service, and I am sure that they will involve the voluntary sector.
	On the issue of accreditation, vocational qualifications are moving towards a system of unitised credits, so it will be possible for someone to put together a vocational qualification having done part of a course here and part there.
	That is attractive and sensible. However, it is not sensible for us to start putting a lot of money into completely unaccredited courses that cannot contribute to an overall training or qualification record for the individual. Despite what is often said by advocates of unaccredited courses, there is little evidence that they are helpful in enabling people to get into work or stay in work.

Rob Marris: During the Queen's Speech debate on training, Cabinet Ministers said that every young person would have a legal right to an apprenticeship. Today, my right hon. Friend said that increasing the number of apprenticeships in England from 250,000 to 400,000 would be subject to high quality employer places being available. Will he assure me that if not enough apprenticeships are available in the private sector the numbers will be made up in the public sector?

John Denham: I can certainly tell my hon. Friend that we want significant expansion of public sector apprenticeships. Some parts of the public sector, including the Ministry of Defence, have a tremendous record in providing high quality apprenticeships; others, including some but not all local authorities, the health service and so on, provide relatively few. We shall want to encourage such provision in any case. We hope to achieve the legal right for young people by 2013. However, I do not want to mislead the House; we could achieve the 400,000 England total without actually reaching the full number we would need to meet the young person's guarantee—that will take longer on any trajectory. I do not want to achieve the numbers of apprenticeships at the cost of quality, so it is right that we always caveat the target. We have put aside the money, a major review of apprenticeships is going on and a draft Bill on apprenticeships will be published later this year setting out our plans. All that will be aimed at ensuring we get the number of apprenticeships we want as well as high quality. There is no point in giving young people a guarantee if it is not a guarantee of something they actually want.

Julie Kirkbride: Earlier, in seeking to dismiss the figures given by my hon. Friend the Member for Havant (Mr. Willetts), the Secretary of State significantly did not mention the number of advanced apprenticeships. Can he inform the House of the number of advanced apprenticeships over the last few years and tell us what plans he has for those schemes? A lot more people will reach level 2 qualifications, but if we are really serious about building skills for the future we need a lot more people to do an awful lot better than they do at present.

John Denham: We need to remember that this is all relative; there were only 75,000 apprenticeships when the Government came to power, but there are 250,000 now. The completion rate for level 3 apprenticeships was not good and we have massively increased and improved the completion rate for level 2 apprenticeships. One of the issues the apprenticeship review will examine is options for an increase in apprenticeships at higher level. As a step in the right direction, in our recent guidance to the Learning and Skills Council we asked for 30,000 new apprenticeships—10,000 a year—aimed specifically at over-25s who want to retrain or up their skills to a higher level. I think that will be the first time provision has ever been made for a dedicated apprenticeship service for over-25s.

Chris Bryant: May I ask the Secretary of State about one of the most excluded groups in Britain—teenage mums? As he knows, we have the second highest level of teenage pregnancy in the world and the highest in Europe. All the evidence suggests that girls who underachieve at school are the most likely to get pregnant under the age of 16 or 18 and that those who become teenage mums are the least likely to complete their education. Will my right hon. Friend consider launching a particular effort to try to cut teenage pregnancies by increasing educational opportunities?

John Denham: I am sure my hon. Friend is right. It is an issue that the Secretary of State for Children, Schools and Families, my right hon. Friend the Member for Normanton (Ed Balls), is pursuing with the Department of Health. It is enormously important. It is also important that there is the possibility of a second chance for teenage mothers so that, having started a family much earlier than they had planned, or possibly wanted, they can still get back into the world of work. One of the reasons why we want the new advancement and careers service to reach into places such as Sure Start children's centres is to make it clear that there are options to go back and train and to have a second chance to gain the skills and qualifications that were missed at school. We must make sure that such advice is available in the places that young teenage mothers are likely to go and where they are likely to be with other people who can support them to take up a training option even if they missed out at school.

Nicholas Winterton: Does the Secretary of State not accept that his Prime Minister actually appreciates the achievements of the Thatcher Government despite what is said by those on the Government Benches? It is important to understand that.
	Does the Secretary of State not also accept the point made by my hon. Friend the Member for Havant (Mr. Willetts) that secondary schools underplay and underestimate the importance of vocational training, which is now provided in the main by colleges? What extra money is therefore being given to the colleges of further education, such as Macclesfield college, that do so much to provide the skills that are required by the industrialists and the commercial companies of this country?

John Denham: Vocational training should obviously be properly recognised in every part of the education system. That is one of the reasons why my right hon. Friend the Secretary of State for Children, Schools and Families has brought forward proposals not only to introduce but to extend the range of diplomas, which for many young people will be able to bring together academic and vocational studies. It is also one of the reasons why the machinery of government was reorganised to give the Department for Children, Schools and Families a clear focus on 0 to 19-year-olds and particularly on 14-to-19 policy. It is very important that there is a coherent plan in each area for the different routes available to young people at 14 and that must include the option of a good vocational education, including the option of a pre-apprenticeship in school and going on to an apprenticeship at 16. I hope that the effects of these reforms overall will be to ensure that all children receive guidance that a vocational course is a very good course to take if it is right for their skills, aptitudes and ambitions.

Gordon Marsden: My constituents in Blackpool will very warmly welcome what the Secretary of State has said about the abolition of the 16-hour rule, about the extra help for small and medium-sized businesses and particularly about the support for lone parents, of whom there are high numbers in this country. However, does he agree that the reskilling of older workers in particular is as vital as upskilling? To that extent, will he confirm that, as part of the overall approach, the Government are looking to have an all-age strategy for advice and guidance and, in so far as they are able to do so, they will make it clear to local authorities with budgetary considerations that they should do likewise?

John Denham: First, I pay tribute to the work that my hon. Friend has done on the issue of skills, particularly as part of his leadership of the all-party skills group.
	Of course, this is not purely a strategy for younger members of the work force. Everybody will recognise why a priority is given to lone parents and to under-25s because of the long-term costs to them of being locked out of the world of work and becoming totally dependent on the benefits system. However, the overall approach has to apply right across the work force. That is one of the reasons for creating apprenticeships aimed directly at the over-25s, and it is another reason for changing the "train to gain" system so that it can include those people who already have a level 2 qualification if their employer is taking part in "train to gain". The advancement service is clearly there for them as well.
	The challenge of getting the work force that we need in this country by 2020 means raising skills right across the work force. Some 70 per cent. of that work force have already left school and the grim truth for our economy is that we cannot achieve the skills levels that we want by focusing solely on those who are currently in school or have left school in the past few years.

John Redwood: Are the Government going to withdraw benefit if someone refuses a training place or a job on offer?

John Denham: We have said today—my right hon. Friend the Secretary of State for Work and Pensions has said it—that it has been agreed that there will be pilots for mandatory training. That will come in after six months if a personal adviser is, first, convinced that somebody should undertake a skills health check and, secondly, that it would be directly relevant to them to get training. Although the details have to be worked on, I suspect that it will also take place after somebody has refused to take up the offer of extended support, such as up to eight weeks of full-time training with a training allowance. Most people in the House would take the view that the system should operate to provide people with every possible bit of advice, encouragement and support to go back into training, but there is a point at which somebody has to say, "If you haven't taken the opportunities, you can't expect not to do anything about it."

Terry Rooney: I welcome the thrust of my right hon. Friend's statement, but I take exception to one point. There is absolutely no evidence that moving lone parents to a JSA regime will produce the effect that has been mentioned. His last words, about encouraging people to participate, reflect the right approach—not being punitive. Is he aware that the big four supermarkets employ 600,000 people and 200,000 a year leave—most of them are women and a large percentage are lone parents—because they are given no skills, no encouragement, no training and no prospect of advancement? What does that say for the skills pledge that all those companies have signed?

John Denham: The detail of the proposals to lower the age—the children's age—at which lone parents can continue to claim income support, and other changes to the JSA regime, were consulted on in the summer. The Department for Work and Pensions has just come to the end of the consultation period and will deal with the detailed issues that my hon. Friend raises when the results of that consultation are announced in due course. However, there are things that most people will welcome in today's announcement—particularly the roll-out of the employment retention allowance, part of which is aimed at dealing with the sort of short-term problem that can force a lone parent out of the labour force, when otherwise they would keep their job. It is sensible to get lone parents to focus on their skills needs well before the time when they might potentially lose their entitlement to income support. So there is a period of two years during which, by definition, the children will be at school—there will be extended schools to cover the hours—and the lone parent will have time to gain qualifications. Those changes to the regime are sensible and will have a positive effect on the lives of many lone parents.

Hywel Williams: Plaid Cymru and the Scottish National party welcome, in particular, the changes to the 16-hour rule. Any further investment in skills is very much welcome too. The Secretary of State said that claimants will be helped to gain core skills, including English language skills where needed. Welsh language skills are occupational qualifications for many jobs in Wales. Will the Government make extra, consequential help available to the National Assembly to take on this extra burden?

John Denham: This is one of those moments when my gratitude for the fact that this is a dissolved responsibility— [ Interruption. ] Not dissolved, devolved. This is one of those moments when my gratitude for that fact knows no bounds. However, I will draw the matter to the attention of the relevant colleagues.

Richard Burden: The statement contains a number of useful initiatives, but will my right hon. Friend say a little more about the 16-hour rule? That rule has been a barrier not only to young people, who have not been able to fulfil their potential by getting back into education, but to people who have lost their jobs. Up until now, we have sent out a ludicrous message by telling them to retrain and then cutting their benefit if they do. How are the changes intended to work, not just for those on incapacity benefit, but more broadly?

John Denham: First, on incapacity benefit—an issue on which many Labour colleagues have campaigned for a long time—we have said that we will remove the 16-hour rule in relation to housing benefit completely for short-term recipients of incapacity benefit so that they, like long-term IB claimants, will always be able to take up the training they need to return to work. We will consider whether it might be practical to define limited exemptions from the 16-hour rule for specific groups such as young people living in supported accommodation—an issue that has been pushed strongly by the Foyer movement. In addition, under the JSA regime, there will be the possibility that after the six-month point has been reached, the DWP or the Jobcentre Plus advisers will have greater discretion to offer a training allowance for up to eight weeks of full-time training, where that is judged clearly to be what an employer needs to get an individual back into work.

Andrew Selous: Will the Secretary of State clarify whether it is still the case that people who have enormous difficulty in reading, writing and counting can still be in receipt of JSA for six months without any requirement that they receive help in upgrading those skills? Is that not a real worry, given that two thirds of all JSA claimants each year—around 1.6 million people—are making repeat claims, so many claimants are going in and out of work before the six-month period, with very low skills?

John Denham: One of the reasons for ensuring that the initial skills check is more rigorous than the current check is to ensure that those whose basic numeracy and literacy problems have not been tackled in the past are correctly identified and directed towards the areas where they can receive assistance. We have also said, and I said this afternoon, that further down the process, we will pilot mandatory training for those whose personal adviser judges that that is the major obstacle to getting somebody into work. In doing that, we will look at the experience that we have gained from a prior attempt to pilot the scheme, which did not produce a big return to work. We believe, though, that particularly with the development of the employability skills programme that was introduced jointly between my Department and the DWP just this August, we are clearer about the type of work-related training that can successfully deliver the very skills to which the hon. Gentleman refers, and therefore make the piloting of mandatory training more plausible than it may have been in the past.

Karen Buck: In the Westbourne ward in my constituency, 83 per cent. of all children are growing up in workless households only a mile from the west end, not because those people lack ability or because they lack motivation, but because of the multiple challenges of high housing costs, high child care costs and a mismatch between skills and the labour market. Will my right hon. Friend consider areas such as that being used as a prototype to test various measures, and in particular to examine the issue of job sustainability? It is not entry into the labour market, but keeping work that is the problem. Will he undertake to examine why some areas and some groups of people face particular problems maintaining themselves in work?

John Denham: I pay tribute to the high level of work and sustained commitment that my hon. Friend has given to this area of interest. I cannot say this afternoon where the prototype areas for the advancement service will be, but I am sure that if the right group of people could be put together locally, we would certainly be interested in proposals coming from her area. She rightly identifies the complex set of issues that individuals often have to face in moving successfully into work. Rightly, I have emphasised to the House this afternoon the importance of skills, but I have also emphasised that often it is not skills alone that will make the difference to somebody's ability to progress.
	It is worth my reinforcing what I said in my statement about our overall aim—that is, we will ensure that long-term unemployed lone parents and those on incapacity benefit are better off in work, even after reasonable transport costs. That will be done by ensuring that long-term benefit claimants moving into work will see an increase in their income of at least £25 per week for, I think, a six-month period. That commitment and the changes that will be made to implement it will be significant in my hon. Friend's area.

Tim Boswell: I understood the Secretary of State to say that there would be up to 500,000 improved and more rigorous skills health checks a year. Can he, in conjunction with his Secretary of State colleague, assure us that there will be sufficient people with the ability and skills to carry out those skills health checks, that the checks will be rigorous, appropriate and not peremptory, and that they will be supported by people and advisers who know not just about job placement, but about careers development and the educational attainments that are appropriate to the scheme? If there is to be a single skills result, there must be a multi-skills offer for those people.

John Denham: The hon. Gentleman has made a constructive point, which relates to one of the reasons for having a number of pilot or prototype areas. There will be different ways of bringing together in local areas people with the various skills that he has described. We need to invite people to suggest the best ways of achieving the aim that I have set out this afternoon.
	To be clear, two types of skills checks are being talked about. One is the original, simple—although hopefully more rigorous than it is today—skills check for the new claimant to identify their basic skills needs. The 500,000 skills checks or health checks for those in work and the other 500,000 for those out of work are the more comprehensive assessment, which would look at everything—existing vocational qualifications and skills needs other than basic numeracy and literacy. Rather more will be taking place than the hon. Gentleman took from my earlier statement.

Anne Begg: The Secretary of State's announcement this afternoon, with all its meaty proposals, stands in stark contrast to the lightweight proposals on the skills agenda that have come from the new Scottish National party Government in Scotland. Like many others, I welcome the abolition of the 16-hour rule in housing benefit; that was acting as a real barrier against people with disabilities getting back into the workplace and into training.
	Has the Secretary of State looked at the physical barriers against disabled people going into training? There is an excellent access to work scheme that helps disabled people going into work to get adaptations or equipment that they need to access the workplace. Is it time for an equivalent access to training scheme, which would help disabled people to get into college or university for whatever training they need, so that they can upskill and get into the workplace?

John Denham: My hon. Friend has made a good point. With others, my Department has to publish a single equality strategy, and I assure her that as part of that we shall look again to ensure that we have identified the issues that she has raised and to see whether further things should be done. My hon. Friend has made a valuable point and she is certainly right to pay tribute to the access to work programme, which has helped many people.

Mark Pritchard: Does the Secretary of State agree that there is a great deal of difference between an inability and a disability, and that British citizens who do not speak the English language have an inability, not a disability? If he agrees, what progress does he think he will make on the issue in the next 12 months? What target has he set himself for getting people who do not speak English, and who are unable to work as a result, into the workplace?

John Denham: The hon. Gentleman will know that we have recently made a couple of important changes to the English for speakers of other languages arrangements. First, we want to ensure that the budget, which is three times as big as it was just four or five years ago, is better targeted and that those who can afford to pay, and should reasonably be asked to, make a contribution towards the cost of their training. We want to do that to make sure that we target those in greatest need.
	Secondly, we have introduced an ESOL for work programme for more recent migrants. That is paid for, but we think that it will meet the immediate workplace needs. I think—and I suspect that the hon. Gentleman does—that the challenge comes from those long-term residents, often British citizens, who do not have the English language and are therefore excluded from many activities of wider society. I assure him that we shall continue to look closely at the ESOL system and how it operates to see what we can do further to target resources on those people.

David Clelland: Does the Secretary of State agree that transport costs can be an obstacle to those who want to take full advantage of the opportunities available to them? Will he support the north east regional youth assembly in its campaign for concessionary travel for those between the ages of 16 and 19 who want to pursue further education and training across the region?

John Denham: I pay tribute to my hon. Friend's imaginative initiative in raising an issue that is beyond my departmental responsibilities, in respect of funding for 16 to 18-year-olds and transport policy. I cannot answer directly about any proposals on that particular age group. However, I draw attention to the commitment to which I have already referred a couple of times today: we intend to ensure that long-term unemployed lone parents and those on incapacity benefit are better off in work, even after reasonable transport costs. That will be done by ensuring that long-term benefit claimants moving into work will, for a period, see an increase in their income of at least £25 a week. That applies to workers older than the group to which my hon. Friend referred; we clearly have plans to raise the participation age and so on. I shall draw his question to the attention of my right hon. Friends.

Charles Walker: Hertford regional college in my constituency is undertaking a major new build programme to create a campus in Turnford fit for the 21st century. However, it will have to pay a VAT bill of more than £3 million for that building work. When secondary schools do new build work, they are not subject to VAT. Will the Secretary of State make representations to the Chancellor on behalf of the further education sector to see whether we can end that inequality?

John Denham: Bearing in mind that 10 years ago there was no capital budget for further education colleges at all, I am fortunate to be presiding over a budget of £2.3 billion for FE colleges over the next three years. It is a bit of a cheek to complain about the VAT rules that applied under the previous Conservative Government.

Charles Walker: It is a genuine question that deserves an answer.

John Denham: But it is worth making the point that the difference between schools and colleges is that colleges are incorporated as independent institutions, which gives them a different tax treatment. I have not yet met a principal of an FE college who wished to return to local authority control, even if they would be able to reduce their VAT bill as a result.

David Chaytor: I welcome the statement, particularly the great expansion in the number of apprenticeships. Does my right hon. Friend agree that the people at the bottom of the pile in respect of access to jobs and skills are ex-offenders? Although his statement makes reference to offenders who have secured a job before their release being able to benefit from "train to gain", the majority of offenders are not in that position. Does he agree that providing more advice, guidance, support and assistance for offenders after they leave custody is important both in its own right and as an incentive to reduce reoffending?

John Denham: My hon. Friend is absolutely right to talk about the importance of offender education. I understand that the number of learner hours has increased by 35 per cent. in the past year alone. However, I would not like to lose sight of the significance of today's announcement. We know that one of the things that most reduces reoffending is an offender's knowing that they are working towards a guaranteed job when they leave prison. Including such offender learning within "train to gain" means that it will now be possible for an employer who is prepared to take on an offender to get their training paid for once they have left the prison estate. That could make a big difference to future reoffending rates, and it should more than justify the investment involved.

Roberta Blackman-Woods: Does my right hon. Friend agree that unlike the Opposition, who wrote off huge chunks of my constituency with the closure of the mining industry, these proposals will continue to extend people's opportunities not only to get into work but to undertake vocational training and to upskill, and that that is important not only for individuals and their communities but for the economy as a whole if it is to prosper?

John Denham: My hon. Friend is absolutely right, both about the historical attitude of the Conservatives and in recognising that the statement says that the world has changed and moved on. When we came into power, we had to deal with the backlog of people who had previously been written off and the backlog of a party that had said that mass unemployment was a price worth paying. Today, the issue has changed. Unless we raise skill levels not only for people who are still workless but for millions of people in work, we will not be able to be a prosperous country in the future, nor will we be able to ensure that nobody is left out. The challenges have changed; today's announcement is about how we will meet those challenges.

Orders of the Day

Health and Social Care Bill

Order for Second Reading read.

Alan Johnson: I beg to move, That the Bill be now read a Second time.
	This is an important Bill introducing improved and integrated regulation of the health and social care system as well as enhancing the regulation of health professionals who work within it. It will help to assure safety and quality of care for all patients and service users. The Bill will also set new regulatory measures where they are necessary, and enhanced regulation where it is appropriate. It will expunge provisions that are out of date and that no longer meet the needs of patients and service users.
	Those measures are essential to meet the challenges of 21st century health and social care provision. What was once the single biggest worry for patients—long waiting times—is now far less of a concern. Before we came to power it was common for patients to have to wait 18 months for operations. By the end of next year, patients can expect to wait a maximum of just 18 weeks between being referred by their GP and beginning their treatment. I stress that that will be the maximum waiting time. We expect that most patients will be treated within eight or nine weeks of referral. However, as the spectre of long waiting lists evaporates, patients' expectations change with the times. Regulation of health and social care must keep pace with new demands, demographic change and medical advances.
	This Bill will create a new integrated regulator for health and adult social care in England, the care quality commission, with tough new powers to inspect, investigate and intervene where providers fail to meet safety and quality requirements. Crucially, where infection control and hygiene are poor, the new commission will be able to act quickly and decisively. It will bring together functions from three existing statutory bodies—the Healthcare Commission, the Commission for Social Care Inspection and the Mental Health Act Commission—and will build on the expertise of those organisations.

Joan Humble: I thank the Secretary of State for giving way at an early point in his speech. He will be aware that there is some concern in the social care sector that social care should have exactly the same status as health care under the new commission. Sadly, in the past, that partnership has been unequal. Will he assure me that the new commission will treat social care with the same importance as it does health care?

Alan Johnson: My hon. Friend raises the crucial issue with regard to the plan to merge the three current regulators. Social care must have parity in the new commission. That must be reflected on the board of the new commission and in everything that the commission does. I am pleased that she has given me the opportunity to reassert that that is the case, and that it needs to be the case. That point will be emphasised throughout the passage of the Bill.
	I emphasise again that the Bill brings the vital role carried out by the Mental Health Act Commission into the heart of the care quality commission. That will strengthen the monitoring of the Mental Health Act 1983, and offer increased oversight of the treatment of patients subject to compulsory detention. I know that the MHAC places great emphasis on its visiting programme, covering each hospital and each ward that accepts detained patients. I expect the new commission to continue that approach.
	The Government recently published their response to the consultation on the future regulation of health and adult social care in England. The consultation highlighted clear support for an independent, integrated regulator with a stronger focus on assuring safety and quality. For the first time, the regulation of the national health service, social care and independent sector providers will be carried out by the same organisation. As services become jointly commissioned and the boundaries between health and adult social care are broken down, it makes sense for our new integrated regulatory framework to work across those boundaries as well.

Mark Pritchard: On the issue of joint commissioning, does the Secretary of State recognise that, as is so often the case, there is perhaps inadvertent confusion about whether the local authority or the primary care trust pays for a particular package of care? Within that confusion, it is often the patient—the consumer or end user; the person who needs services—who is subject to extra stress and burden, because they are being written to day after day by someone saying, "It is not our partnership; it is not our problem." Such people are falling between two stools. Will the Secretary of State give a commitment to the House that the Bill will address those key issues?

Alan Johnson: I accept that things are not perfect. Practice-based commissioning, which is quite new, has still to attract genuine buy-in. Lots of people say that they operate practice-based commissioning, but it is not operating as we would like. The question is not just about the Bill, but about other measures, too. World-class commissioning, which we are working on and will launch shortly, is aimed at ensuring that people do not merely talk the talk on commissioning, but walk the walk.

Andrew Lansley: The Secretary of State talked about the independence of the new care quality commission. If a chairman of the Healthcare Commission were required now, the appointment would be made by the Appointments Commission under the Health Act 2006. In the Bill, the Secretary of State proposes that the chairman and members of the care quality commission should be appointed by the Secretary of State. Why is he reducing the independence in the appointments process?

Alan Johnson: We will need to discuss that point as the Bill goes through the House. With a joint integrated commission, it is the Secretary of State's role to make that appointment. It is a far more fundamental position, and such an approach is a necessary part of accountability to Parliament.
	The new registration system for providers of health care and adult social care, which will cover both public and independent provision, will set the requirements that every registered organisation will need to meet. They will include requirements relating to infection control. With the creation of a new registration system for all registered activity, patients can rest assured that the care or treatment that they choose will be from providers who have demonstrated compliance with the same key safety and quality requirements, no matter where that treatment is provided.

Rob Marris: I think that this is the appropriate point to mention that psychotherapists in the United Kingdom sometimes have a qualification, and sometimes do not. Sometimes that qualification is bogus; sometimes it is not. Sometimes they also have a medical qualification; sometimes they do not. The situation is a mess. Inexpert psychotherapy can be harmful to patients, who may think that they are receiving psychotherapy from someone who is properly trained. Indeed, the patient may think that the individual is a psychiatrist, which is entirely different—although some psychiatrists are psychotherapists, too. Will my right hon. Friend consider introducing regulation for psychotherapy under the auspices of the Bill?

Alan Johnson: Not as part of the Bill, but as a separate exercise, we are seeking to clarify precisely those areas that my hon. Friend has rightly mentioned.

Rob Marris: My right hon. Friend is very accommodating.

Alan Johnson: I do my best.
	We expect that the vast majority of providers will continue to demonstrate that they deliver quality services in a safe, clean environment. However, the Bill will introduce a wide range of enforcement powers that the commission will be able to use when registered providers fail to deliver safe, high quality care.

Kelvin Hopkins: In the run-up to the Bill, the Government have talked about lightening the burden of regulation for health and social care providers. Is that not worrying? Providers such as one or two that provide elderly persons' care in my constituency have closed down for failing to meet standards. We should be putting to the fore the safety and welfare of residents, not the burden on providers.

Alan Johnson: My hon. Friend makes a fair point. Of course, the new regime will involve a risk-based assessment, whereas previously providers received the same amount of treatment irrespective of whether they had a good record or even a record that was exemplary year after year. Usually the visits were determined by Government, not the regulators. The point of risk-based assessment is to ensure that organisations that have an excellent track record can experience either light-touch regulation or even no regulation, unless there is a problem. Meanwhile, the regulator can concentrate its attention on providers who have not met those standards. The two things go together. The essential point is that many organisations found themselves being visited by different regulators, and one regulator could carry out that function. I believe that that is an important step forward, without in any way compromising the important points raised by my hon. Friend.
	Once any activity is registered, the commission can apply specific conditions to respond to specific risks, such as requiring a ward or service to be closed until safety or infection control requirements revert to the expected standard. The current Healthcare Commission can issue infection control improvement notices to NHS trusts only when it considers that the improvement will not be achieved in any other way. The new commission will not be restricted in that way. It will be able to visit trusts more frequently, close down wards and insist on their being thoroughly disinfected before they can be reopened. It could follow that up with more unannounced spot checks. It can also carry out annual infection control inspections of all acute trusts, using teams of specialist inspectors.
	More generally, the commission will have the power to issue warning notices and penalty notices or instigate court proceedings to levy fines on any provider breaching registration requirements. When NHS bodies incur fines, the money will be returned to the local commissioners and reinvested to improve services, so that the local population does not lose out. The Bill also provides for the commission to undertake periodic assessments and reviews of care. The new commission will help reduce the burden of regulation on providers from itself and other public inspectorates through gate-keeping powers, which mirror those for other inspectorates, and through targeting activity where it is most needed.
	The public expect value for money from their public services. In bringing together the regulation of health and adult social care in one regime, we will streamline regulatory activity and ensure that the commission manages its budget effectively, adopts a more independent and intelligent approach to regulation and provides a sharper focus on safety, quality and cleanliness.

Rob Marris: I thought that I would ask this question before the Opposition asked it, because the streamlining to which my right hon. Friend refers means bringing together the Commission for Healthcare Audit and Inspection and the Commission for Social Care Inspection, which are two bodies—I appreciate that a third body is also included—that the Government statutorily established only four years ago. Why the change after only four years?

Alan Johnson: As usual, my hon. Friend asks a pertinent question. If we consider the history, we see that there was no regulation before 1999 apart from that under the Mental Health Act 1983, which was an important development that the previous Government introduced. When the two new regulators were introduced, there was a debate in Government about whether they should be merged immediately—whether we should have one regulator for the health service and for social care, while recognising that a separate regulator already existed for mental health. At the time, it was decided that that would be too much in one go, so the two separate organisations were set up but a process of evolution meant that, almost as soon as the Healthcare Commission was established in 2004, a proposal was made in 2005 to merge the two bodies. We are therefore considering a natural evolution. There will be no great change in the organisations' functions, apart from the important change for which the Bill provides, which is all about integration. Taken together, the provisions will make regulation of providers more efficient and more responsive to people's concerns. With social care and mental health as vital components, we will have a regulator that reflects the reality of integrated care delivered effectively to all patients, whatever their needs.
	The Bill will also improve the regulation of the health professions and social care workers. Let me be clear from the outset that the overwhelming majority of health care professionals show remarkable expertise and exceptional commitment in their dealings with patients. They are as disturbed as we are about the rare occasions when a practitioner falls short of the high standards that they set themselves. That is why, as a society, we hold the professions in such high esteem and place so much trust in individual practitioners.
	Earlier this year, the Government published the White Paper "Trust, Assurance and Safety", which set out wide-ranging reforms to the way in which health professionals are regulated. Those reforms build on the far-reaching recommendations in Lady Janet Smith's inquiry into Shipman and the report "Good doctors, safer patients" from the chief medical officer. Although the bulk of the legislation to implement the reforms will be effected through secondary legislation, the Bill will enact four key provisions.

Andrew Lansley: I am grateful to the Secretary of State for giving way again. He will know how frequently the hope has been expressed in the House that when we legislate to follow up Dame Janet Smith's recommendations we will do so not only in respect of health professional regulation, but in respect of coroners and death certification. It was clear in a debate in Westminster Hall back in July that it was the Government's intention and hope to do that, but there is no coroners Bill in this Session to accompany the Health and Social Care Bill. Why not?

Alan Johnson: That is a matter for the usual channels. I do believe that we listed that Bill, but whether we shall find time for it in this Session is as much to do with the Opposition as it is to do with us. If we get the Health and Social Care Bill through speedily, we shall have more time available.
	The Bill will enact four key measures. The first is to ensure that all the professional regulatory bodies use the civil standard of proof, so that the General Medical Council, the General Optical Council and the Nursing and Midwifery Council operate to a method consistent with the other eight health profession regulators. The second measure is to create an independent adjudicator, initially to adjudicate on fitness to practise cases for doctors, to enhance public and professional confidence in the impartiality of the GMC's judgments. The third measure is to ensure that health care organisations employing or contracting with doctors appoint a responsible officer to identify and handle cases of poor professional performance by doctors, and to make recommendations to the GMC for revalidation. The fourth and final key measure is to pave the way for the creation of a new general pharmaceutical council.
	The Bill will also make a number of other changes to arrangements relating to the composition of councils of the regulatory bodies, to the Council for Healthcare Regulatory Excellence and to the legislation currently governing the regulation of the social care work force.

Peter Bottomley: Clearly the Committee, on which I do not expect to serve, would be the place to go into this point in great detail, but has the Secretary of State consulted the judges, who have laid down that if someone's job was at risk, the civil standard of proof would not be high enough? They have laid down that in some serious cases the criminal standard ought to be used.

Alan Johnson: I cannot say whether we have consulted the judges; all I can say is that eight of the current regulatory bodies operate in accordance with the procedure that I have set out. Our consultation suggested that there was wide-ranging support, including, incidentally, from the GMC—the recommendation stemmed from Dame Janet Smith's inquiry into Shipman—which believes that there should be a change from the criminal standard. The other argument, which is probably the clincher, is that if a case against an individual doctor was that serious, the criminal benchmark would apply. For all those reasons, the proposal has a widespread consensus behind it. I cannot say whether that consensus stretches right through the legal profession, but we have a strong enough argument to proceed on that basis.

Kelvin Hopkins: rose—

Rob Marris: rose—

David Taylor: rose—

Alan Johnson: Before I give way, I should like to record my appreciation of the thoughtful and constructive approach that the professional regulatory bodies have taken to the proposals.

Kelvin Hopkins: My right hon. Friend mentioned ensuring that we have a sufficiently skilled and qualified work force. However, there are fears that work force registration will not be sufficiently enforced and that some people might slip through the net, possibly creating two-tier provision. Will he assure us that everyone in the work force will be properly registered and properly qualified?

Alan Johnson: Up to a point, Lord Copper. Given the procedures that we have set out in the Bill and the arrangements that apply quite separately, it is difficult to envisage anything further that we could do to ensure that. However, we are always willing to accept ideas and suggestions as we take the Bill through Committee. The Bill will also introduce a number of public health measures.

David Taylor: I am grateful to my right hon. Friend for giving way, Mr. Deputy Speaker, and I shall seek to catch your eye later in the debate. Just moments ago, I tabled early-day motion 386, which calls for citizens councils—as recommended in the NHS plan 2000—to be involved with the regulation of health care professionals. Does my right hon. Friend believe that the public, as patients, are sufficiently involved in the process of setting and reviewing the criteria for admission to the various professions and for continuing to practise in them? The evidence is that the public feel cut off from that process.

Alan Johnson: There are separate arrangements to ensure that the patient has a clear involvement. The other provision that arises from Dame Janet Smith's inquiry into Shipman is that there will no longer be a majority of professionals on these bodies; there will be equality for lay people. That offers an important reassurance.

Rob Marris: I thank my right hon. Friend for giving way with his usual smiling generosity. He referred a few moments ago to what might alliteratively be described as poor professional performance under this regulatory regime. Would that cover the surprising approach being taken by some GP practices, including some in my own constituency, and I believe by NHS Direct, of using 0845 numbers, which are a rip-off for the consumer—in this case, the patient? If this regulatory regime will not cover that practice, will he assure me that he will look into the matter? GPs are getting paid handsomely and properly by the state, yet some of them seem to wish to make extra money out of their patients' phone bills.

Alan Johnson: My hon. Friend has raised an important point, but this is not a matter for the Bill. I am already well aware of the practice that he mentions, however, and we issued guidance earlier this year to say that patients should pay no more than the cost of a local call. Indeed, we believe that to charge in the way that he has described breaches the terms of the GP contract. The matter does not need the weight of this legislation, or the time that it would take to pass the measures, to deal with it.

Angus Robertson: The Secretary of State will be aware that many parts of the Bill will be subject to a legislative consent motion in the Scottish Parliament. Will he confirm my understanding that there has been excellent input by the Scottish Government and excellent consultation in Scotland on these measures? Is he content, as I am, that the provisions in the Bill are exactly what is needed?

Alan Johnson: I can confirm that there has been excellent co-operation, both before and after May 2007. That has really helped us to arrive at the provisions—particularly those on public health, which I shall come to in a second—that will ensure that the whole of the UK is well equipped.
	The Bill introduces measures to help to prevent and control the spread of diseases that could present significant harm to human health caused by infection and contamination. The measures in the Bill will update the existing powers and provisions in the Public Health (Control of Diseases) Act 1984 relating to preventing and controlling disease. That legislation is clearly out of date. For instance, it allows us to regulate the risks from rag and bone men while remaining silent on the dangers of chemical and radioactive contamination.
	The Bill seeks to bring our health protection into the 21st century by taking an all-hazards approach to health protection rather than by focusing only on specified diseases. That will allow a quick response to new or unknown diseases. I emphasise that the new legislation will be proportionate. We are updating the legislation to ensure that, while we have the powers needed to respond effectively to a public health threat, safeguards are written into the new legislation to ensure that the powers are used only when appropriate, and only to the extent necessary to secure the protection of public health.
	The Bill will also support the health of pregnant women by introducing a new health in pregnancy grant. The grant will be a universal, one-off payment of £190, available to all expectant mothers ordinarily resident in the UK from the 25th week of their pregnancy. It will provide pregnant women with additional financial support towards meeting the costs of a healthy lifestyle, including diet, and other costs in the run-up to the birth.
	There are also a number of small amendments in the Bill relating to the financial arrangements for pharmaceutical services; indemnity schemes in connection with the provision of health services; direct payments in lieu of provision of care services; repeal of the liable relatives rule; definition of ordinary residence as applied to the National Assistance Act 1948; payments to social enterprises; the creation of a national information governance board, ensuring that parents get automatic feedback about their child's health through the national weighing and measuring programmes; and the functions of the Health Protection Agency in relation to biological substances.

Gordon Prentice: May I ask about the Bill's implications for the health service ombudsman and whether an increase in the number of complaints is expected? If so, will the ombudsman be adequately resourced to handle them?

Alan Johnson: There may be an increase in the number of complaints, but the new commission will not deal with them; they will go through the usual channels. We will stay in touch with the ombudsman to see whether staffing is sufficient to ensure that they can cope with any increase in work. I am sure that all the miscellaneous items that I have mentioned will receive due attention during the Bill's passage through the House.
	The Health and Social Care Bill will deliver a range of measures to assure the levels of quality and safe care that all patients and care service users have a right to expect. It will also introduce legislation that updates our current health protection powers to make them fit for purpose in the modern age and contribute to a healthier lifestyle for both expectant mothers and young children. I commend the Bill to the House.

Andrew Lansley: I am grateful for the opportunity to speak on Second Reading. The Secretary of State says that the Bill is important. I do not dispute that it has important implications, but it seems that its importance was not such that the Prime Minister thought fit to refer to it at all at the start of the Gracious Speech debate. It is customary each year for at least one health Bills to be a flagship Bill, as it were. Unfortunately, this year the health Bill is not so much a flagship as a fleet auxiliary—useful measures grouped together in much less visible form that never acquire the status of a flagship.
	I am afraid that this Bill in no way represents the changes in overall regulation that are required. After the 2005 election, the Government believed that there should be a wider review of regulation. They commissioned a review by Lord Currie of Marylebone and others, but they then more or less ignored it. They proceeded to publish consultation documents—frankly, inadequate ones—about the regulatory review, which culminated much later than originally intended in the document to which the Secretary of State referred.
	This Bill implements only one aspect of all that—the part that relates to the Healthcare Commission—but it is perfectly clear that it will not achieve the regulatory changes necessary to provide assurance in the longer term to those providing services to the NHS. If one believed in the long-term role of the independent sector, for example, in supporting the NHS, one would need not only powers of inspection for the commission, but an independent regulator to undertake economic regulation in respect of market entry or market exit. Since 2003, the Government have failed to introduce legislation for the failure regime or for the exercise of powers relating to competition and pricing. None of that is in the Bill: it is not the legislation that we really need to provide either autonomy or proper accountability.
	We have made it clear that we will introduce the necessary legislation in this Session and we will endeavour to ensure that it complements the aspects of the Bill that we support. In the course of the Bill's passage, we can do certain things to make it more consistent with our long-term structure and vision for health care.
	Before exploring some of the Government's proposals in more detail, let me isolate one point. What is lacking in the Bill—for example, in respect of the structure of the care quality commission—is any formal structure to give a voice to patients and the users of services. Members—particularly those who are present—will recall that when legislation was introduced during the last parliamentary Session to abolish patients forums and set up local involvement networks, we thought it important for patients to have the national voice that was missing from that legislation. The same applies to social care for care users and, indeed, carers. This Bill provides no such national voice. Although clause 2 enjoins the care quality commission to have regard to the views of patients, no structure is built into the Bill to make that happen.
	The Secretary of State intends the care quality commission to bear comparison with other regulators, but such structures are explicitly incorporated in many other regulating bodies. The Office of Communications, for instance, has a consumer panel, set up under the statute that inaugurated it, whose purpose is to acquire patients' views. That is one of the reasons why, in the measures that we propose, we will make specific provision for HealthWatch—working alongside the Healthcare Commission, or the care quality commission, as it will become—to represent patients and express their views on the health service to the whole regulatory structure and the Secretary of State. The same could, of course, apply to those using social care.
	Conservative Members will seek to amend this Bill to bring those principles into effect. Back in 2005, when Lord Currie of Marylebone presented his report to the then Secretary of State, he made it clear that such a national voice for patients was an essential part of a future structure.
	The hon. Member for Wolverhampton, South-West (Rob Marris) kindly asked part of the question that I had intended to ask the Secretary of State. However, I recall from my membership of the Standing Committee considering what became the Health and Social Care (Community Health and Standards) Act 2003 that at that time we abolished the Commission for Health Improvement, which I think had been around for only about three years, in order to establish the Commission for Healthcare Audit and Inspection, now colloquially known as the Healthcare Commission. It does not seem as though any of those bodies had been entrenched for any length of time before being abolished, and the same is true of the Commission for Social Care Inspection. The National Care Standards Commission was abolished in the 2003 Act, CSCI was established, and no sooner is it up and running than we are to abolish it.
	I would not wish the House to be in any sense misled. We believe that there has always been a strong case for those bodies to work side by side. We have always supported the proposition that we must try to break down the barriers between health and social care, and institutional divisions in the regulatory structure do not help that to happen. If we are to encourage, for example, the use of individual budgets and personalised care stretching across health and social care, it clearly makes sense for the regulatory bodies to work side by side.
	On the commissioning side, the current position in Herefordshire, where the primary care trusts and the local authority have effectively merged their activities at executive level, suggests that a single organisation could be helpful. The relationship between Ofsted and CSCI in respect of children's services is a good example.
	While I am happy with the principle that the two bodies should be merged, the central issue—as the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) rightly said and as the Secretary of State rightly accepted—is that when social care and health care are brought together there is a natural, or perhaps unnatural, tendency constantly to prioritise health care to the exclusion of social care, and to make mental health a Cinderella within health care. There is an inherent danger that bringing everything together under one regulator will cause both the functions currently performed by the Mental Health Act Commission and those performed by CSCI to attract less priority than the current functions of the Healthcare Commission. I have no doubt that the more often we say that during the passage of this Bill, and the more persistent we are in Committee about the nature of the duties—we shall have to spell that out clearly, as the duties are expressed only in the vaguest terms in current legislation—the more likely we will be to ensure that this body delivers what is intended. In my experience, the more independent a regulator needs to be, the more important it is that their duties, including the factors to which they must have regard, are spelled out in legislation; otherwise, that independence will be undermined—or if there is independence, the more likely it will be that the regulator behaves in ways that do not attract the support of the House.

Hilary Armstrong: Will the hon. Gentleman also reflect, however, on the fact that too often this House has added so many details to regulatory legislation that instead of regulators being able independently to work out the most effective form of regulation, processes have become bureaucratic and tedious and there has been a failure to achieve the overall objective? The House must give the powers to regulators so that they are able to use them effectively, rather than try to tie them down so much that they spend their time ticking boxes instead of understanding what is happening on the ground and ensuring that people can get hold of the information they need to know whether things are working or not.

Andrew Lansley: I am interested in what the right hon. Lady says because under other legislation enacted by this Government the view has been that it is rather important to set out those duties—in relation to an energy regulator, for example, that it is important to set out the duty on security of supply, the duty on promoting competition and the interests of consumers and the duty on the achievement of environmental objectives. I do not think it would have helped to have said, "We are setting up a regulator who has a duty for the improvement of energy services," which is more or less what is happening in the current context: a regulator is being set up with the duty to improve health and social care.
	How is the regulator to define that? The answer, which is built into clause 2, is that it is to be defined by reference to the Secretary of State and Government policies. Clause 2(4) re-incorporates into legislation what is currently section 130 of the National Health Service Act 2006 in respect of the Healthcare Commission.  [Interruption.] Yes, I am showing off now. That pretty much says that both the Healthcare Commission and CSCI have statutory provisions under which they must have regard to the policies of the Secretary of State. Therefore, when the Secretary of State says, "This body will be independent," we will take a very close look at what that means. Strictly speaking, "independence" should mean independently appointed, with independent duties established by Parliament, and with an ability to pursue the duties of, for example, safety, quality, efficiency and effectiveness to whatever conclusion. It should not mean having that compromised by the way in which the Secretary of State sets out his policies.
	It is evident that much of the burdensome regulation that the Healthcare Commission has to undertake in relation to health care providers is the direct consequence of the way in which successive Secretaries of State have set out the targets that they want health care providers to meet. Therefore, the target culture is a direct precursor of the burden of regulation. It is more important for us to be focused on the delivery of the duties of quality, safety and efficiency instead of having that overridden by the Secretary of State. I am sorry that that has been such a long digression, but it has been a helpful one from my point of view, so I am grateful to the right hon. Lady.
	It is important to pursue the question of risk-based regulation. Although the Secretary of State says that it will be risk based, I am unclear whether the Bill delivers that. It is certainly intended to be proportionate to the risk that is to be safeguarded, but it could easily be said that all health care providers—depending on what they do—have more or less the same kind of risks attached to what they do. We must look hard at this Bill to incorporate into it the principles of risk-based assessment and regulation, because they are not in it yet. I hope that as the Bill progresses we can ensure that the care quality commission has not only a specific role as a national voice for patients, but specific ways in which it takes into account the interests of patients, care service users and carers.
	The Secretary of State talked about health care-associated infections. This feels a little like the groundhog day of health legislation, because it is almost exactly two years ago that I was standing here responding to the Secretary of State's predecessor, who was telling us that the 2006 legislation was the last word in regulation, and that the Healthcare Commission was to have these new powers. In fact, the commission can carry out unannounced inspections. At the time, the Government looked at and we discussed the question of fines. They concluded that the best thing to do was not to introduce them, and that it was better to have a process of improvement notices.
	I do not know what evaluation has taken place. The code of practice set up under the 2006 legislation came into force on 1 October 2006. We are less than a year down the line of the introduction of that code of practice, and although I am not aware of how many inspections there have been, there were an initial 15 inspections for compliance with the code of practice. I do not know to what extent the Secretary of State regards this as a successful or a failed regime. One improvement notice has been served, against Chase Farm hospital, and we have yet to have others.
	I simply do not know what the evidence base is for the Government's concluding that their policy failed and that they must have a new one. The cynics among us might suspect that in fact, from the Secretary of State's point of view, a new Secretary of State must equal a new policy, and a new policy must equal new activity. Perhaps when he asked the Department, "What is it that we have not done that we could do in respect of health care-associated infections?", he was simply served up something that his predecessor had rejected. That is often how these things happen, and I am afraid that this looks a lot like that.
	I should be very disappointed if it were felt that this Bill or the role of the care quality commission itself was a sufficient response to the demands of tackling infection control. We debated this issue last week, so I will not travel down all the paths associated with it, but it is clear that on the Maidstone and Tunbridge Wells NHS Trust, for example, the Secretary of State is hiding behind the Healthcare Commission as though it were not an inspectorate coming in to establish to what extent a body is failing in its duty to provide care; instead, he seems to be regarding it as a performance management organisation. However, it is not; as things stand, it is the strategic health authority's responsibility to manage the performance of the Maidstone and Tunbridge Wells trust, and the Department of Health has line management responsibility for the performance of the SHA. However, given the events surrounding the trust, it looks to me as though performance management was ignored.
	The Secretary of State talked about world-class commissioning. However, the primary care trust clearly subcontracted its responsibility for infection control and quality to the health protection unit. Effectively, the PCT played no role in determining the quality of the services being provided to patients at Maidstone and Tunbridge Wells. Likewise, the SHA subcontracted its responsibility to the health protection unit, which did not get involved until an outbreak had been notified. Even then, it did not have the necessary powers. So the Secretary of State needs to think hard, and we should think hard, not only about how we strengthen the role of an inspectorate in assessing from the outside where things are going wrong, but about ensuring that performance management works more effectively inside the national health service, because at the moment, it clearly does not.

Rob Marris: I take the hon. Gentleman's point, but may I also suggest that he think hard, as many of us do, about trying to strike the right balance between decentralisation and local control, and national priorities for a national health service? Both our parties struggle with that.
	An example of that balance can be seen with hospital-acquired infections. If asked, people say that they want local control of their health facilities. They say that until something goes wrong or until they perceive a disparity of provision, which is sometimes called a postcode lottery. They then say, "We are worse off than the people next door" and they ask why somebody, usually Whitehall or the Government, does not sort it out. Hard thinking is required to strike that balance, and the Conservative party needs to do some of that.

Andrew Lansley: We have done quite a lot of hard thinking about this matter. I do not know whether the hon. Gentleman has had occasion to read the autonomy and accountability white paper that we published in May, but it expressly addresses these issues. For example, it makes it clear that the independent allocation of resources to try to achieve greater equivalence in access to health care across the country relative to the burden of disease is important. Figures that I published yesterday demonstrating the wide disparities across the country in expenditure per cancer patient are largely associated with that. Even if one were to equalise the allocation of resources relative to the burden of disease, it would not mean that the same amount would be spent, because different parts of the country would have different priorities. I do not believe that we could ever reach the point where the centre could mandate how much is spent, but a nationally funded national health service should have a national allocation system that is at least geared towards providing equivalent access to health care services for people in the same circumstances.
	We can also be clear that commissioning guidelines and standards can be established nationally, which is why the Bill reproduces existing legislation. Standards should be set nationally, and the care quality commission, whose task is to assess performance against those standards and provide information on that, should be in place. I do not know what the Government's view is for the future, but I think that the role of patient choice and decentralised commissioning then becomes all the more effective, because performance against those national standards can be taken into account and can help to drive the local response in terms of what is being delivered. That is our view, but heaven only knows where the Government stand on patient choice.

Rob Marris: I thank the hon. Gentleman for that thoughtful response. I have not read every word of that shadow white paper, and he will correct me if I am wrong about this next point. I recall that after its publication in May the Conservative party proposed a policy of increased localism—I use that term in a broad sense—and at the same time called for a national moratorium on any proposals to close an accident and emergency hospital unit in England. That gets the balance a bit wrong; I am not saying that the Government necessarily have that balance right, but that is why I was politely suggesting that he should think a little harder about this balance between localism and centralism.

Andrew Lansley: The hon. Gentleman is, in a sense, misdirecting himself, because a moratorium is just that—it stops a process that is under way.

Rob Marris: It is a local process.

Andrew Lansley: No, it is not a local process. This is why the hon. Gentleman is misdirecting himself. Our proposal to impose a moratorium on what is happening is us saying that we will not countenance—or would not have countenanced had we taken office following an election—a process whereby national clinical directors and Ministers in the Department of Health wander around telling people what they should be doing. They should be going to places such as the constituency of my hon. Friend the Member for Worthing, West (Peter Bottomley), where the national clinical director is saying to people that there has to be a drainage population of 400,000 plus in order to provide an accident and emergency service. That is clearly not justified by the evidence. Subsequent material, such as the report published by the Academy of Medical Royal Colleges, makes it perfectly clear that accident and emergency departments serving smaller populations are entirely viable.
	What I am saying is entirely consistent, because I believe that the clinical evidence and the decision making should combine locally. The clinical evidence will not all be derived locally, and indeed much of it will be prepared by the professions nationally, but it has to be interpreted into local circumstances and be the product of local decisions. Under this Government, it is not the product of local decisions but of national influence and determinations from the centre.

Peter Bottomley: I am grateful for my hon. Friend's reference to the situation at Worthing and Southlands hospital. I think that the primary care trust will now have another serious look at the issue, and I am grateful to the Secretary of State if he was quietly involved in that, as I suspect he was. I put it to my hon. Friend that it is wrong for national standards to come from papers written by tsars that are not peer-reviewed, contain no evidence and are, in effect, a series of anecdotes.

Andrew Lansley: I agree, and that is at the heart of the issue that we have presented. It is unacceptable for local managers to receive documents from the Department of Health that are not evidence-based or peer-reviewed, and are inconsistent with the professions' collective view. Such documents are presented as though they are clinically driven and have to be translated locally, just because they are written by someone who happens to work in the Department. That is not acceptable.

Alan Johnson: I would be interested to know exactly which part of Roger Boyle's document the hon. Gentleman disagrees with.

Andrew Lansley: I was talking about accident and emergency departments, so I meant George Alberti's document. However, the same point can be made about Roger Boyle's document. He presented an argument about the need to centralise stroke services, but—as the Secretary of State knows—there is no model for doing so. There is no basis for knowing what the necessary catchment population should be, for either acute care of stroke or the concentration of services for primary angioplasty. The pilot studies on primary angioplasty have not reported, been peer reviewed or provided evidence. But Roger Boyle produces his document, and the Prime Minister and others stand at the Dispatch Box and say that services must be centralised on that basis. That is why we propose a moratorium: so that such issues—the design of stroke services or cardiac interventions based on evidence—can be structured locally on the basis of evidence, rather than assertions from the Department of Health.
	I shall now return to the subject of the Bill, Mr. Deputy Speaker. The House will recall the passage of the Mental Health Act 2007, and it is extraordinarily important that the introduction of community treatment orders—and the extent of compulsion under them—is the subject of independent scrutiny. That will be the role of the Mental Health Act Commission, and I hope that it will be made clear during the passage of this Bill that that should happen.
	When the Minister of State winds up, I hope that he will tell us when we may expect the proposed section 60 order on the governance of the General Medical Council, because it would be helpful to consider that alongside the broader proposals to shift towards parity in lay and professional participation. The Secretary of State will know that we have accepted some of the principles. We accept the principle of parity, but we do so in the context of helping to support confidence in professional self-regulation, not helping to undermine it. I hope that during the passage of the Bill we will explore carefully the proper role of the office of the health professions adjudicator and why it has to be operated independently from the GMC. If we believe in professional self-regulation, we should be able to structure the regulation in a way that keeps the functions of investigation and adjudication within one body, even if they are functionally separate.
	The Department appears to assume that responsible officers will be in place in April 2009, but that is a heroic assumption. For a start, I am not sure that it is right to assume that in most cases the medical directors of primary care trusts should be the responsible officers.

Rob Marris: Eighteen months?

Andrew Lansley: I believe so. I understand that the date is April 2009, but if I am wrong the Minister will let us know. I think the time scale is too rapid—it is a heroic assumption.
	Should a responsible officer combine clinical governance responsibility with the assumption of part of the management responsibility? Let us consider that point in the context of primary care. If GPs as contracting providers have a developing relationship with the primary care trust, is it necessarily right that the responsible officer as a member of the PCT board should also have responsibility for their clinical governance arrangements? I have no doubt that clinical governance should be improved and strengthened, even more so in primary care than in secondary care, but we must do that in a way that commands the greatest possible confidence among the professions. It is important that clinical governance be conducted by somebody who has only that responsibility, with no risk of conflict of interest with other responsibilities.
	I repeat my question about the scrutiny process of the professional practice of doctors. On the one hand a revalidation structure is being set up; on the other, where there is the possibility of serious failings there are fitness to practise investigations and, in the middle, there is the question of what happens when someone has difficulties in their professional practice that are not such as would give rise to an investigation by the GMC. Such cases are pursued by the National Clinical Assessment Authority, alongside the National Patient Safety Agency. I have never understood why. If there is a spectrum of issues relating to professional practice, from making sure that people are up to date to the correction of serious problems, one body should be responsible for all of them.
	On standard of proof, the Opposition Front-Bench team have made it clear that we accept in principle that we should move from a criminal to a civil standard. The medical profession is concerned that the loss of livelihood of its members would be accomplished on the basis of a more-likely-than-not calculation and, it would argue, on evidence that might not substantiate the loss of livelihood and its resulting impact on the individual. I do not think the profession is right about that; it is important to recognise that in practice a graduated scale is applied by tribunals, and courts, even with a civil standard of proof, which relates the nature of the evidential test—the quality of the evidence provided—to the penalty that would eventuate from the conclusion that somebody was guilty of an offence.
	We need to make it clear in the legislation that that is the case, to try to set minds at rest, and that it is true, as my hon. Friend the Member for Worthing, West in effect said in his intervention on the Secretary of State, that when a court is presented with the proposition that somebody will lose their livelihood—which is very significant for doctors, as they may not easily be able to pursue another career—there must be almost a criminal standard of proof before that result is achieved. I think that that is pretty much what the court was saying—so there is a precedent for saying that the civil standard of proof must be applied in a way that is sensitive to the nature of both the allegations and the evidence. As we incorporate that provision in the statute, we must attempt to give the medical profession that assurance.

Howard Stoate: The hon. Gentleman is making a balanced argument, but if we use the civil standard of proof how will he ensure that we word legislation that allows us to slide up the scale towards the criminal standard for some offences and not for others? How can we make that clear without it leading to more and more legislation as people take tribunals or the GMC to court because they did not get the answer they wanted?

Andrew Lansley: The hon. Gentleman's expertise is medical, not legal, but those who write the legislation will have to try to ensure that the guidelines are at least very clear. We will have to see to what extent they can be incorporated directly into the primary legislation and in the schedules to it, but I am sure that the House will have noted his declaration of interest in these matters—or not.
	I will not delay the House on the part of the Bill dealing with public health. On the face of it, the updating is pretty straightforward. The powers requiring people to be quarantined or to submit to medical examination if they are infectious have been extended quite a long way, so we need to ensure that the safeguards exist. I have no doubt that there should be such powers but, taking the wider view, I just wish that we also had public health legislation that helped to achieve the things that we have proposed to create a much stronger separately funded public health service that works with local authorities to deliver better on our public health objectives.
	The Secretary of State will know that only a third of the dedicated public budget of £300 million that the Government have allocated since the White Paper "Choosing Health: Making healthy choices easier" has been spent on public health objectives. He will also recall that Ara Darzi's document on "A Framework for Action" in London expressly sets out the fact that primary care trusts spend on public health in inverse relation to their deprivation. For example, Tower Hamlets, which is one of the most deprived areas in London, spends £6 a year on preventive health spending.

Rob Marris: Per capita.

Andrew Lansley: I beg the hon. Gentleman's pardon. Tower Hamlets spends £6 per head, whereas the Bromley primary care trust, which is not among the most deprived, spends £33 per head per year on its preventive spend. Frankly, that is an outrage.
	The Secretary of State did not dwell at length on the issue of health in pregnancy. My hon. Friend the Member for Eddisbury (Mr. O'Brien) has reminded me that I am taking up some time, but I will talk about more things than the Secretary of State mentioned; we need to mention some things that he did not. The health in pregnancy grant was announced in the 2006 pre-Budget report as something that would merely bring forward child benefit payments to pregnancy, but it now has a slightly different character. It is not designed in precisely the same way.
	I have two questions about the grant. Is it to be administered entirely by Her Majesty's Revenue and Customs and will it be paid for by the Treasury directly? I will not dwell on HMRC's administrative potential and the nature of the data that will have to be supplied, when they will be supplied, by whom they will be supplied and to whom HMRC may supply them. The House needs an answer because there is no impact assessment to tell us not only what the overall costs will be but who will pay the cost of implementation of £8.4 million in the next financial year.
	The Secretary of State seems to think that the health in pregnancy grant is the best way of spending the relatively large sum of £175 million a year to support nutrition in pregnancy. May I direct him to the draft guidance from the National Institute for Health and Clinical Excellence that was published just a couple of months ago? Paragraph 3.5 says:
	"Interventions which ensure that a woman is nutritionally equipped for pregnancy are likely to have the greatest effect if delivered before conception and during the first 12 weeks".
	Later the guidance considers the gaps in the evidence and says:
	"There is a lack of well-designed interventions on how to...improve the nutritional status of women before and during pregnancy".
	It adds:
	"There is a lack of well-designed studies that have evaluated the use of food vouchers to encourage health eating."
	Let us leave aside the simple fact that the grant may be spent by pregnant women on things other than what is necessary for their diet. The guidance also gives rise to the question as to whether this is a well-calculated and evidence-based intervention even in terms of improving diet.
	That brings us to question of weighing and measuring children. It has always been our argument that not only should children be weighed and measured, but there should be an effective follow-up. I see nothing yet in the Bill—perhaps the Secretary of State will add more in terms of policy—about an adequate follow-up. The report from the National Institute for Health and Clinical Excellence clearly shows that universal interventions by midwives, health visitors and school nurses are critical. However, what is the actual situation? Let us consider health visitors. In 2004 there were 10,137 full-time equivalent health visitors. By 2006, that figure had reduced to 9,376. It is clearly not possible for us to deliver the kind of improvements in childhood obesity that we want to see, when the number of health visitors is declining.
	Let us consider what the Government have said about school nurses. The then Minister of State said in March 2006:
	"Because we know school nurses make such a difference, we want at least one, full-time qualified nurse working with every cluster of primary schools and their related secondary school by 2010."
	There are 3,343 secondary schools in England. According to the Minister of State, Department of Health, the hon. Member for Exeter (Mr. Bradshaw) on 23 October this year, there were 815 full-time equivalent nurses with the appropriate nursing qualification working in England. So we are nearly 2,500 short of what is required by— [ Interruption. ] The hon. Member for Wolverhampton, South-West says from a sedentary position, "Cluster." There are 3,343 secondary schools. The policy is for one full-time qualified school nurse per secondary school and its cluster of primary schools. I am using the number of secondary schools, so the comparison is entirely valid.
	On the social enterprise investment fund, I welcome what the Government are proposing, and the benefit of that. We already know the potential impact of social enterprise in the health care sphere, if only by reference to what hospices do for palliative and end-of-life care. In that context, it is astonishing that the Government are going down this path without at least ensuring that they have provided, through the publication of the end-of-life care strategy and the development of the tariff for palliative care, a full cost-recovery structure for hospices, if they wish to take it up, for the delivery of end-of-life and palliative services. Hospices are social enterprises that do a remarkable amount, and they should at least have the option—even if they are not required to do this—of providing services to the NHS in a fully supported way.
	The Government propose, under clause 134, to extend direct payments. We have always welcomed that. Some Members will recall that when the "Our health, our care, our say" White Paper was published on 30 January 2006—excuse me, Mr. Deputy Speaker, but I am going to quote myself—I said:
	"Will the Government legislate to allow direct payments to extend across health and social care, so that patients with long-term conditions can control the management of their care?"
	The then Secretary of State replied:
	"The hon. Gentleman...mentioned the extension of direct payments, not only to social care but to health. That sounds like the revival of the patient's passport."—[ Official Report, 30 January 2006; Vol. 442, c. 26-29.]
	In the White Paper, the Government said:
	"It has been suggested that we should extend the principle of individual budgets and direct payments to the NHS. We do not propose to do so, since we believe this would compromise the founding principle of the NHS that care should be free at the point of need."
	I did not agree with them then and I do not agree with them now. Interestingly, Lord Darzi said in his interim report:
	"we need to learn how to support and allow eligible service users increasingly to design their own tailored care and support packages. This could include personal budgets that include NHS resources."
	The Government have done a complete U-turn. Will they say today that they will incorporate in the Bill the necessary provisions to allow individual budgets and direct payments to extend across health and social care, in the way that Lord Darzi has made clear he now supports?
	Finally, on the pharmacy contract, there is a proposal to transfer the global sum into the hands of primary care trusts. Will the Secretary of State—or the Minister of State, when he replies to the debate—acknowledge that thus far there has been a pitiful take-up of most of the advance services that would have delivered precisely what the Prime Minister, when he became Prime Minister, said that he wanted— pharmacies that offer more screening, more lifestyle support and more opportunities for people to access sources of advice and information about their health?
	That is not happening under the current pharmacy contract. It needs to be transferred from the Government to the primary care trusts, and the Government should make sure that there are sufficient incentives for the pharmacy contract to do what was intended, as distinct from pharmacies getting a global sum as a consequence of the manipulation of category M list prices.
	This is a portmanteau Bill. The Secretary of State has arrived with his bag full of lots of tricks, most of which have been in gestation in the Department since long before he arrived there. None the less, some of them will be useful. Many of them will require scrutiny during the passage of the Bill, but none of them, as put forward by the Government, constitute the long-term sustainable vision of how health and social care can be regulated in a way that will deliver the improvements in standards that we all so long for.

Kevin Barron: I declare an interest. In 1999 I was appointed, along with two other Members of the House, to the doctors' regulatory body, the General Medical Council, and in 2003 I was reappointed to the new council by the National Health Service Appointments Commission, and I still sit on that body.
	I am pleased that the Bill is before the House and that we are considering the introduction of a care quality commission, which will have tough powers to deal with the safety and quality of care. We have just heard the hon. Member for South Cambridgeshire (Mr. Lansley) speaking from the Opposition Front Bench about how important performance management is in the national health service. I agree with him about that. It is difficult to grasp who is responsible for what. Over time, a regulator that deals with the quality of care could answer many questions about the differences in treatment that patients—our constituents—sometimes experience between one establishment and another.
	Also, bringing together the regulation of health, adult social care and mental health care should ensure a more consistent approach to regulation. The regulation of social care will represent a large part of the work of the new regulatory body. Hopefully, it will implement our manifesto commitment to strengthen clinical governance and the regulation of health care professionals.
	During the last general election when I was a candidate and not a Member of the House, I spent an evening in Tameside talking to a group of people who were relatives of the victims of Dr. Harold Shipman. After talking to them for two or three hours, the need for a change in regulation was all too apparent. Because of the dreadful consequences that their families had faced, those people knew more about regulation than many health professionals or Members of the House. Health and social care professionals should be more accountable to the public as well. I hope that that is implicit in the aims of the Bill.
	The merger of relatively new regulatory bodies will have to be handled carefully. There is always a danger of losing effectiveness when change takes place, as people are left wondering whether their position will exist in a few months. The Select Committee on Health, on which I sit, has often found that change tends to take people's mind off what they should be doing. Care must be taken that that does not happen when the merger proposals in the Bill are implemented.
	Having been on the General Medical Council for many years, I have more than an outside interest in these matters. I am interested in the doctors' approach to the Bill. The British Medical Association is moving a little closer to where it should be as the representative of the vast majority of doctors. The tone of its press releases a few months ago, one of which was headed "Doctors' leader warns of 'assault' on the medical profession", has changed. I am pleased that it has, because I do not think that there is an assault on the professionals at all. I frequently meet doctors up and down the land who do not feel that what is happening is an assault on the profession.

Howard Stoate: I am sure that some members of the medical profession would, rightly or wrongly, feel threatened by a change in the burden of proof from the criminal to the civil standard. We need a supportive culture that emphasises the education and retraining of doctors who have difficulties and encourages doctors to speak out about problems that they see for themselves and others. If we are to produce that supportive culture, which in the end would lead to better patient care, we have to make sure that doctors do not feel threatened.

Kevin Barron: I agree entirely; my hon. Friend is a practising doctor and knows such things better than I. However, what I mentioned has been the case for all the years that I have been on the General Medical Council—and probably since the council was first brought into being. Sadly, that does not mean that it is the actual practice on many occasions. That is why some of the detail in the Bill is important.
	Let me cite two things that the BMA said in its brief for this debate:
	"The BMA also has concerns about the removal of the adjudication function from the General Medical Council...and therefore the creation of a separate body, the Office of the Health Professions Adjudicator. We are also very worried about the role of the proposed 'responsible officers' because we see them as having a conflict of interest between their various roles."
	It also says:
	"The BMA strongly opposes Clause 104 which imposes a requirement for all the health professional regulatory bodies and the new Office of the Health Professions Adjudicator to use the civil standard of proof (the balance of probabilities)"—
	that has just been alluded to—
	"in fitness to practise cases. The General Medical Council currently uses the criminal standard (beyond reasonable doubt). It would be an injustice to remove a doctor's livelihood based on a lower standard of proof than is used currently."
	I can only say that I think that the BMA is wrong. Having discussed the issue with numerous doctors, I also think that many doctors think so too. However, one thing in the brief that I agree with—I want to put it on the record as well, and I hope that the whole House agrees with it—comes on page 1:
	"The vast majority of doctors perform well and safely, and acknowledge that it is imperative that patients are protected from the small number of cases of unsafe doctors. The BMA therefore fully supports measures that promote excellence in medical practice and that help to reduce instances of poor standards, negligence or criminality among doctors."
	I agree wholeheartedly with the first part of that: the vast majority of doctors do look after us as we would expect, and we should have confidence in them.

Peter Bottomley: May I use this question to prompt the Minister later, although that may require a bit of work? Does the right hon. Member for Rother Valley (Mr. Barron), the Chairman of the Health Committee, agree that the civil standard in professional cases rises up towards the criminal level? There are not two totally separate standards. We could get advice on this, but I do not think that the BMA need be too worried if the current acceptance of what the judge has laid down for civil standards does indeed rise if a doctor's ability to go on practising is at stake.

Kevin Barron: That is absolutely true. I have the evidence that the General Medical Council received on that matter. There were two clear cases in which the civil standard was increased on that basis. In one, the allegations were made under the civil process, but they were serious allegations that needed serious action. I shall allude to that issue further in a few minutes.
	What is taking place is not new in respect of quitea lot of the regulation of doctors, of which I have experience. In 2006, the GMC published a package of proposals designed to deliver a modern framework of independent and accountable medical regulation,and the Government's White Paper, "Trust, Assurance, Safety: The Regulation of Health Professions in the 21st Century", reflected a lot of the GMC's own paper. The GMC is confident that its current arrangements for adjudication lead to consistent and high-quality decisions. The hon. Member for South Cambridgeshire referred to separate adjudication and said that the BMA might have concerns in that regard. As things stand, the GMC would not disagree with that. It has changed its adjudication panels massively since I first became a member in 1999. I was involved in the changes in governance between 1999 and 2003 that made adjudication as independent from the statutory body as it could be.
	The BMA's parliamentary briefing says on page 3:
	"The BMA does not believe the case has been made for establishing a separate body and does not accept that the medical profession should lose the authority to regulate itself."
	It is fundamentally wrong for the BMA to use words like that. In my experience of the GMC, it has not been a case of doctors protecting doctors—far from it. In the years prior to 2003 when I sat on fitness to practise panels, there was never a case of lay members versus doctors in terms of wanting to come to a decision on a doctor. Such words do not do the profession any good. Sadly, some people still think, wrongly, that it is about doctors protecting doctors—no wonder, when one sees such words in briefings given to Members of this House for the purposes of a debate.
	The GMC has accepted the Government's decision to establish an independent adjudication body and will use its expertise to help to ensure the smooth transition from where we are now. When we changed the GMC's governance in 2003, the one thing that we could not do was to appeal against any decisions by the adjudication panels, because we had made them independent. I remember going to meetings of the adjudication panels as a lay member, trying to talk the case through with them, and then saying, in a nice way, "We think you got that decision wrong." At least the GMC will now be able to appeal against decisions of the adjudication panels. The GMC is pleased that the Government have accepted its view that it should have the right of appeal, have made it clear that the GMC remains the owner of professional standards, and are protecting in legislation the relationship between the new body and the GMC in the application of the principles of good medical practice. Good medical practice is what the GMC judges all its doctors against, and the fact that it remains in statute is a very good thing.
	The GMC believes that patients' best interests are best served by independent and accountable regulation. The GMC must be independent of Government as the dominant provider of health care in the UK, independent of domination by any single group, and publicly accountable to Parliament. In response to the hon. Member for South Cambridgeshire, who said that a draft section 60 order is likely to be published at some stage, it was published today, and it looks into some of the areas that he mentioned. The GMC's current model of governance is that there should be parity between medical and lay members without an in-built majority on the council for either. We should aim for an equal proportion of medical and lay council members—a 50:50 split—on the new council that will emerge from the section 60 order.
	I remember when we moved from a GMC of 124 members, which was by and large dysfunctional—it was a bit like being in Parliament except that Division bells did not ring so we never took a decision on anything; at least that happens here, as dysfunctional a body as we may or may not be—to a membership of 35. A 50:50 split is right and proper. We will see how that will work in the next few days in the details of the section 60 order. The GMC should also have a balanced composition that reflects those who receive and provide health care across the UK—patients and the public, doctors, the NHS and other health care providers, medical schools and medical royal colleges. That is crucial. If it cannot be done numerically, it can be done by ensuring that people on the council have the breadth of experience to play a useful role.
	The civil standard of proof will apply in any case without the Bill. The GMC decided that quite a long time ago, upsetting the profession well before Ministers did so by publishing the Bill. That mode of travel was suggested by Dame Janet Smith, and it will apply whether we change regulation procedures or not. I will loan my hon. Friend the Member for Dartford (Dr. Stoate) my legal opinion on that and he can read it for himself. The GMC's president, Sir Graeme Catto, is on record as saying that he does not believe that the change will result in more doctors being erased from the register, but it should make it easier to impose appropriate restrictions on a doctor's practice where that is necessary to protect patients. Removing a doctor from the register is a very serious matter, and where the consequences are loss of livelihood, the rigour of the criminal standard of proof, or a standard close to it, is clearly appropriate. On the other hand, the consequences of sanctions other than erasure may be less profound, and that could be taken into account in the evidence required to reach a finding on the civil standard of proof. That approach is wholly consistent with protecting patients and the public interest, and with being fair to doctors.
	The GMC's legal advice makes it clear that the civil standard of proof is not a rigid criterion by which facts are to be judged, but is to be tailored to the facts of any given case. It is often said that the more serious the facts alleged, the more cogent and compelling will be the evidence required. The application of the civil standard of proof more accurately reflects the true function of the GMC fitness to practise panel. Having had years of sitting on those panels, I completely agree. We would never go for the more serious actions against a doctor without good cause or consider one standard and one only. The panel is not a criminal court and it does not apply the criminal law. In particular, it is questionable whether it is appropriate to retain the criminal standard of proof in a protective rather than criminal jurisdiction, especially when the concerns relate to a doctor's health or performance. That is crucial. The process is there to help the doctor, but often it is too far down the line.

Sandra Gidley: Does the right hon. Gentleman agree that the recent section 60 order provides a lot more flexibility to look at cases where a doctor may have had an ill-health problem, and that whereas previously the only option in such cases had been to strike them off, a more sympathetic approach can now be taken?

Kevin Barron: It has always been the case that the GMC has tried to consider health and performance issues differently, but they may become relevant when the case is presented. When adjudication goes to the new body, recognising issues to do with doctors' health and performance will be as important as the question of what might have happened, although I accept that that depends on the seriousness of the incident.
	The great majority of professional tribunals in various walks of life apply the civil standard of proof; and it is already used by the majority of other health care regulators. During recent consultation—I say this to my hon. Friend the Member for Dartford—several other regulators that apply it confirmed that it did not present them with any undue difficulty. In those circumstances, there should no grounds for the fear put about by representative bodies. The Court of Appeal recently explained that the use of the criminal standard of proof in areas other than the criminal law is very much the exception. The GMC is committed to ensuring that procedures are fair, objective, transparent and free from unfair discrimination, and that they command the confidence and support of all those who receive and provide health care throughout the UK. I believe that the application of the civil standard of proof is consistent with the protection of patients and the public interest, and it is fair to doctors at the same time. I am pleased that such a process will take place.
	I would like to move on to the issue of responsible officers, which was mentioned by the BMA and in the speech of the hon. Member for South Cambridgeshire. There is a need for greater coherence and co-ordination across all levels of medical regulation, particularly locally. Heath care providers have a clear responsibility for effective clinical governance arrangements that ensure that the fitness for purpose of those whom they employ, or contract to provide services, is good. They also must be effective channels of communication between national and local systems, which includes ensuring clarity with regard to matters that need to be addressed locally, and those that should be dealt with by the national regulator.
	While with the GMC, I sat a lot on the interim orders committee before 2003. It would consider a lot of cases without taking final decisions on them. There were cases—not very often—that quite clearly should have been dealt with at a local level; doctors did not need that stress in their lives, or the threat of having to go in front of their regulatory body. Quite often, an exchange of letters was enough to deal with such cases. That raises the question why such cases progressed to the regulatory body in London when most people thought that they could have been handled at a local level.
	The establishment of responsible officers means that for the first time there will be a nominated individual at a local level with a statutory responsibility for fitness to practise matters. Based on my experience, that is a good thing not just for the profession, but for our constituents and for patients. It will build up a confidence that is sadly sometimes not there. The role of responsible officers includes monitoring the conduct and performance of doctors, ensuring that appropriate action is taken in response to concerns about conduct and performance and evaluating the fitness to practise of medical practitioners. That role is clearly, therefore, linked to revalidation.
	Revalidation was promoted by the GMC for many years, sometimes with the support of the profession, sometimes not so much. We need to ensure that doctors working in our health care system are up to date. To be on the register, all they need to do is go through medical school, get on the register, get their number, go into work, and—provided that they do nothing wrong for the next 30 years—they can retire on an NHS pension. Even if they are independent contractors, like my hon. Friend the Member for Dartford, they can retire on an NHS pension, provided that they do nothing wrong. There is no measure to ensure that doctors keep up to speed with new medical practice or to ensure that they are using better services for patients to give them better quality of care than they would have received in years gone by. Having an in situ responsible officer overseeing revalidation, which will come in separately to the Bill or regulations—

Howard Stoate: For the record, we have had reappraisal in general practice for some time and hospital doctors certainly undergo extensive revalidation in order to meet clinical governance regulations. I would not want the House to think that there is no onus on doctors to remain up to date.

Kevin Barron: That is true, but it depends on who is doing the appraisal. I am not sure whether it would be right for someone who works alongside a person to do their appraisal.
	I shall finish on this note, given that my hon. Friend tempts me. I represent a constituency that is covered by the Rotherham district general hospital, which was visited by the famous Gerry Robinson and a BBC crew earlier this year. That was on national television, and my hon. Friend may recall two consultants in the ophthalmic department. One of them would do cataracts only under a general anaesthetic and the other one would do them only under a local anaesthetic. The latter consultant would normally do about six or seven in any one session, and the other would do only three. It is true to say that to some extent the royal colleges might defend that, although the risk of using general anaesthetic is greater than that of using local anaesthetic, but that consultant did not use it because he would not. I thought that that was wholly wrong, and I am pleased to say that he is about to begin a long and happy retirement from the NHS.
	Everyone is obliged to keep up to speed with what is happening in their profession, and Members of this House, of all parties, do so all the time. I do not put in my manifesto what I put in it when I stood for election in 1983. I do not say things in this House that I used to say in 1983 either. We all have a duty to ensure that we keep up to speed in many areas, and the medical profession should have as well. I am pleased to have had the opportunity to relate some of my experience, and explain what the GMC feels about some areas of the Bill. It is a great opportunity for us to advance health care in this country, and have health care that looks after patients, the public interest and doctors as well. I am pleased to support the Bill.

Sandra Gidley: We welcome the broad aims of the Bill, but as always, the devil will be in the detail when we get to Committee. The thought has already been expressed that it is bit of a shame that we are faced with yet another reorganisation. The Healthcare Commission is fairly new, as is the Commission for Social Care Inspection. It would have made more sense to have brought them together three years ago, as the Liberal Democrats suggested at that time. All parties favour a more joined-up approach, but we have to guard against a one-size-fits-all mentality. When we are talking about regulation, we need to remember that what a large acute hospital requires is very different from what might be required when regulating a small domiciliary care agency. Both are important in their own way, but they require different approaches.
	It is also worth putting it on record that the existing regulators have done some excellent work in their differing fields. Concerns have already been expressed that the new body should retain a strong focus on social care. There are fears of health domination. I do not know how well founded those fears are, but health issues are much more high profile in the media agenda and sometimes in this place, so we must do all we can to ensure that social care does not become the poor relation.
	The CSCI has expressed concern that any additional duties for the care quality commission should be adequately and separately funded, such as any duties that might stem from the current focus on hospital-acquired infections, which are also covered in the Bill. Otherwise, it is feared that resources could be squeezed from social care to fund that health agenda. Although we all support money being spent on ensuring that our hospitals are clean and safe, that must not come at the expense of the vulnerable and elderly.
	The CSCI has been fully committed to paying great attention to the views of those who are—I hate the phrase—service users, and their families and carers. It is essential that we retain that process at all costs. Indeed, the Healthcare Commission has been moving in that direction latterly, but there is little in the Bill to provide assurances that the patient's voice, or even that of the carer, will be heard. We can learn a lot from those experiences.
	The Mental Health Act Commission provides for regular unannounced visits to those detained under the Mental Health Act 2007. The frequency of those visits needs to be protected, because it is a crucial tool in ensuring that the rights of the 45,000 people detained each year are protected. Can the Minister confirm what measures will be put in place to ensure that those standards are not eroded?
	It is not clear how the funding will work out, which is causing some concern. The regulatory impact assessment discussed a number of different models, but a wide range of possible costs and savings would apply. We need to be clearer about the detail as we approach the Committee stage. The Royal College of Psychiatrists has raised concerns about some services being squeezed and about whether some of the monitoring and notification work that it undertakes will continue in its present form.
	It would be helpful if the CQC could continue the work of the MHAC in reporting admissions, discharges, deaths and other relevant information on behalf of detained patients. Many organisations suggest a rights-based approach and hint that the Bill has missed a bit of a trick. Clause 44 is welcome, in as much as it gives the CQC the facility to conduct special reviews and investigations into health and social care of a certain type or as provided for certain groups. It is important to consider those with learning disabilities, particularly given the recent example of the Cornwall Partnership NHS Trust. Over the years, concerns were raised by families and carers, and if the CSCI's approach had been taken, those views would perhaps have been taken more seriously earlier. Only when a joint investigation was undertaken by the Healthcare Commission and the CSCI were 64 cases of abuse uncovered that had happened over the past five years. We must remember the background: the trust was given a high star rating while people in its care were abused. We need to ensure through the fine detail of the Bill that such an incident will not happen again. A facility to consider how an organisation treated a group of people with a disability or whether people with a mental health problem were being treated differently would have been welcome.
	The Bill provides us with an opportunity to close the human rights loophole. Nine out of 10 care homes are privately owned or in the charitable sector, and so human rights legislation does not extend to them. Attempts were made during the passage of the Equality Act 2006 to try to introduce some legislation on that matter, but the Government resisted. I hope that they will be more sympathetically disposed on this occasion. Residents of independently run care homes who experience rights abuses cannot challenge their care home provider.
	One example of bad treatment that breaches human rights is that of older people in care homes who are told that they have to move to a different home at short notice, which engages article 8 of the European convention on human rights. Other examples often include disputes about care home visitor hours, restrictions on social relationships and even refusal to allow cohabitation with partners in the same care home. Those examples are at one level, and cases of elder abuse that occur on another level in care homes are, thankfully, a minority. Any abuse should be taken seriously, and the individual should have a chance to challenge it.
	I turn now to professional regulation. I must declare an interest as a member of the Royal Pharmaceutical Society, which will be no more as a result of the Bill. It is somewhat unusual in that it regulates the pharmacy profession but also acts as a representative body. In the post-Shipman era, we are moving towards councils with a parity between professional and lay members. It is difficult for such a body to represent the profession adequately. The Bill will set up a general pharmaceutical council, which is a move that most in the profession now support. However, there are concerns that the move is being foisted on the profession by the Government. Most of the profession seems to feel that there has been a lack of help in setting up a professional body or something akin to a royal college, as suggested by Lord Carter in the Carter review.
	The balance of any health care regulatory council is important. Instinctively, it would seem right that there should at least be a lay majority. That would help the public to have a greater trust in the regulators. There is a perception, whether it is right or wrong—I think that it is wrong—that the professions look after their own. I contend that the opposite is the case. The vast majority of professionals in any health profession do a good job and they do not want rotten apples in the barrel. The professions are quite hard on themselves. As we are always told that an evidence base is needed for introducing any change in regulation and policy, what evidence is there that a lay majority gives a better outcome for patients? I do not think that there is any. Dame Janet Smith and the Shipman inquiry suggested it, but there is no hard evidence that it is better for patients.
	More controversial is clause 104, which seeks to reduce the standard of proof for doctors, nurses and midwives and the General Optical Council from the criminal to the civil. Most of the noise has been made by the British Medical Association on behalf of doctors. However, the General Medical Council, also on behalf of doctors, planned to introduce such a measure anyway, as was mentioned by the right hon. Member for Rother Valley (Mr. Barron). I understand the concerns of individual practitioners, who must instinctively feel that if they transgress they are at greater risk of losing their livelihood. That must add stress and worry. Other health care regulators, including those in my profession, have managed the civil standard of proof well. It is a serious step to strike a health professional off the register, and it is not done unless there is an overwhelming balance of evidence. It is not done on the balance of probabilities. People have to be sure. We also forget that the people who sit on such committees and listen and decide the outcomes are human too. They apply a standard of fairness in such cases.
	Although the right hon. Member for Rother Valley welcomed the concept of responsible officers, that measure is not welcomed universally. The responsible officers will be situated in NHS trusts and primary care trusts in England. All practising doctors will be able to relate formally to a responsible officer, who will be responsible for evaluating doctors' fitness to practise. It is not yet clear where that role will be based. It has been suggested that in a hospital trust, the medical director might be the appropriate person to take it on. However, medical directors already have a heavy work burden and the extent of a responsible officer's work load is unclear. That needs to be teased out in Committee.
	The creation of responsible officers could give greater impetus to resolving problems locally so that they are not necessarily referred up to the GMC. However, conflicts of interest could arise if there were personality differences. Again, we must ensure that the system is seen to be fair in all cases.
	I want briefly to mention the general pharmaceutical council, which is being set up to regulate pharmacists and pharmacy technicians and to inspect premises. I want to draw the Minister's attention to a little bureaucratic overkill. The council will maintain registers of pharmacists, pharmacy technicians and pharmacy premises in Great Britain. That is fine; there is no problem with that. However, the primary care trust also maintains a provider's list of local pharmacies, with the power to suspend or remove. It appears from the Bill that the care quality commission will require a third form of registration from individuals or companies, with the potential to intervene in the same manner as the other two regulators. That multiple registration creates potential for duplication and confusion, as well as giving rise to additional expense for health care professionals. One registration is enough. I must already pay £400 next year to stay on the pharmaceutical register, and there is debate in the profession about whether that constitutes value for money.
	The hon. Member for South Cambridgeshire (Mr. Lansley) mentioned the devolution to PCTs of the global sum for pharmacy services. In theory, that is a good idea because it should enable them to determine the nature of services locally. However, the hon. Gentleman was right to say that there has been a problem with PCTs, which have not commissioned the enhanced services that the pharmacy contract envisaged. In the case of some services, such as pharmacists going into care homes to review medication, the commissioning has decreased since the contract was introduced. Primary care trusts simply do not understand pharmacy or its potential. I therefore ask the Minister whether he will ensure, if the Government are hell bent on introducing the proposal, that proper pharmaceutical expertise in practice-based commissioning is in the right place in the PCT. That will ensure that the money is best used. I make that point not for pharmacists or out of fear that the money might go to GPs instead, but so that we use all the money to patients' best advantage.
	The health in pregnancy grant—a one-off £190 —is a bit of gimmick. The Royal College of Midwives estimates the cost to be more than £120 million, and we heard a different estimate earlier. However, that assumes that there will be no baby boom. The RCM says that it supports the grant in principle, but asks for reassurance that its introduction will not be at the expense of investment in maternity services. It pointed out that the spend on maternity services fell last year by £55 million.
	I felt that child measurement in the Bill was a bit of a tick-box exercise. However, when I looked into the matter, I realised that we have a golden opportunity to do some joined-up thinking. If we get it right, we will have a tool that proves useful for health professionals in identifying early obesity. The earlier we realise that a child is becoming obese, the easier it is to intervene and change the diet. I understand that height and weight will be measured. In themselves, those are fairly meaningless measurements; we should also calculate the body mass index and plot it on a graph. Measuring BMI makes it easier to spot any deviation from the norm and potential weight problems.
	However, according to the press release, parents will be sent the height and weight of their child. If they have access to a computer, they can go on the website and discover their child's BMI. That is pointless because most parents will probably not do it, not everybody has a computer and, most important, there is no tracking. It is important to track the change in BMI. Will the Minister consider the matter and ensure that an opportunity is not squandered in the Bill?
	As well as the Bill's introduction, the Department for Children, Schools and Families will publish its children's plan in December. The plan is expected to include some thoughts on obesity. The Department of Health will also develop an obesity strategy, although the publication date is unknown, and a new child health promotion is destined for the new year. All those measures will be introduced at almost the same time, and it would be nice to have some joined-up thinking so that we can start to tackle one of the biggest public health challenges that we face.
	Much in the Bill is welcome. Some details obviously need to be firmed up, but on the whole, Liberal Democrats support its broad principles.

Joan Humble: I am pleased to take part in a debate on a complex Bill that contains many welcome aspects but also raises many questions. I shall ask my hon. Friend the Minister a few questions and I am sure that even more will be asked as the Bill progresses.
	I want to speak primarily about the care quality commission but start by welcoming some other elements of the Bill. I am sure that the overwhelming majority of pregnant women will welcome £190—the health in pregnancy grant—whether it is to help them with their diet or, as the explanatory notes state, other aspects of late pregnancy, which could do with some extra money.

Greg Mulholland: Surely the genuine concern is about pregnant women's diet. All the health evidence shows that that must be tackled early in pregnancy or even before pregnancy to have an impact. All the social evidence shows that the most concern is about those on the least income—the most disadvantaged. Why, therefore, are we considering a one-off payment late in pregnancy rather than extending the healthy start scheme, or doing both?

Joan Humble: The hon. Gentleman makes an interesting point, but he is not placing the payment in context. A woman must attend pre-natal classes and engage with doctors and health visitors. I anticipate that, when a woman becomes pregnant and goes to her doctor, she will be advised at that stage—all women are given advice about diet, exercise and looking after themselves in pregnancy—that, if she maintains her links with the health service, she will be entitled, at 29 weeks, to the valuable sum.

Several hon. Members: rose —

Joan Humble: I anticipated making only a brief reference to the health in pregnancy grant, but it appears that we must explore the matter. I shall give way first to the hon. Member for Romsey (Sandra Gidley).

Sandra Gidley: It is interesting that the hon. Lady seems to believe that the grant will be linked to attendance at antenatal classes. Antenatal classes in my area have been cut and cut, and there are now not enough for women to attend, so if the grant increases their availability, I shall be delighted.

Joan Humble: The explanatory notes refer to seeking medical advice, which I am sure will mean whatever is appropriate in an area.

Stephen Crabb: The hon. Lady is generous in giving way again. She is being rather bold, as her assumption about how the Bill will work in practice goes beyond what it says. There is no requirement for a series of antenatal classes with ongoing advice about nutrition, just a requirement for a one-off meeting for general advice about maternal health.

Joan Humble: This is exactly the sort of debate that we need to have. In order to access the grant, the woman will have to seek advice. I hope that that same woman will seek advice at an early stage in her pregnancy, as indeed most women do. They either go to the doctor to confirm that they are pregnant or go to the doctor once they have confirmed that personally. I remind the hon. Gentleman that the grant should be seen in the context of other initiatives from the Government, such as Sure Start projects and the expansion of children's centres. Women would have to sit at home and not read a single newspaper, not watch any television and not leave their houses in order to avoid all the advice that they are now given not only about their pre-pregnancy diet and diet once they are pregnant, but about having a healthy lifestyle in general. I welcome the grant and I am sure that it will be appreciated by the overwhelming majority of pregnant women.
	A second aspect of the Bill that I welcome is the removal of the liable relative rule. It is clearly unjust to require a husband or wife to pay for the cost of the care of their spouse in a care home over and above the resident's contribution. Indeed, the overwhelming majority of local authorities do not enforce the rule, so I welcome the fact that we are going to remove it. I also welcome the new public health measures to help to prevent and control the spread of serious disease.
	The extension of direct payments to those who lack capacity, by allowing payments to be made to a suitable person who will manage it on their behalf, is a welcome move, especially for families who have severely disabled children. Those children can access direct payments, which are usually made through their parents. When that child becomes 18, they cannot continue with direct payments, because they will then be an adult lacking capacity, but under the proposed extension they will be able to do so. Other groups will also be able to access direct payments for the first time, including people with dementia, people with learning disabilities and people who may have a fluctuating capacity.
	Will my hon. Friend the Minister offer an assurance that vulnerable people who lack capacity will be protected? The Mental Capacity Act 2005 sets out a functional test for capacity. An individual might lack the capacity to make certain decisions, such as complex financial decisions, but might well be capable of making decisions about their personal care. In the context of direct payments, an individual with learning disabilities might not be capable of managing their finances, for example, but whoever is doing so should ask them what sort of care they want, in order to determine whether they can talk about the care that they feel they should have. Let us not think that the extension of direct payments means removing all decision making from an individual, because the same individual could, within the terms of the 2005 Act, be more than capable of making some decisions, while being incapable of making complex financial decisions.
	I also welcome the transfer of the pharmaceutical global sum to PCTs. PCTs should already be working with pharmacists. Reference has been made in this debate to the new pharmacy contract. I visited my local pharmacy, near where I live in Blackpool, after the new contract was introduced. My local pharmacist had set aside an area for private discussion and consultation. He was looking forward to engaging with his customers and offering them advice. Pharmacists now have a public health role that they should be working to. The transfer of the global sum to PCTs represents an opportunity for them to work much more closely with pharmacies to deliver that important part of the Government's public health agenda, so I welcome it.
	I welcome the Government's proposal to establish the care quality commission, in order to deliver a seamless package of care between health and social care. There are not two different groups of people, one that receives only health care and another that receives only social care. There is already a mix. Sadly, however, some people find it difficult to get a seamless progression of services through health and social care. I was at a meeting with Blackpool PCT on Friday, at which I discussed that very issue. I was pleased to hear that Blackpool PCT is already developing integrated care packages for patients, so that it can look at what an individual needs, from an ambulance to take them to hospital and the acute care that they will receive to the after care that they will need, thereby treating the individual as a whole person, not as a care episode, a health episode, then another care episode and probably another health episode after that. If by introducing the care quality commission the Bill helps PCTs to deliver that sort of integrated package of care, it will be very much welcomed.
	As I mentioned in my earlier intervention on the Secretary of State, there are concerns in the social care sector that social care will be a second-level partner. It must not be, not only because of the individuals receiving that care, but equally because we cannot afford to lose the excellent work that the Commission for Social Care Inspection has done over recent years. Dame Denise Platt has offered leadership to CSCI, which has raised standards in social care, increased the profile of social care and undertaken important research. Above all, CSCI has listened to care users and their carers. I read CSCI's annual report with interest. It is not often that I read annual reports with interest, but every hon. Member should read CSCI's annual report, because it outlines what social care is provided, how it has changed and how it will continue to change.
	I strongly believe that the hard work that CSCI has done needs to be taken forward and put at the centre of developments for the new care quality commission. My question for the Minister is: how is it going to do that? How will the new commission deal with the fact that 24,000 of the 30,000 registered health and social care providers are in social care? The new commission will be dealing on the one hand with NHS facilities and any health facilities that are large and, on the other, with a multiplicity of social care providers, the majority of which will be small independent providers in the private sector—often, small and medium-sized businesses. Bringing together the Healthcare Commission, CSCI and the Mental Health Commission in this new organisation will therefore require changes of practice to address the different forms of facility that the new body will register and inspect.
	It goes beyond that, however. I am talking not only about the nature of the facilities but about the differences, which the commission will address, in policy background in health and social care. Health and social care often start from different perspectives. Heath care usually works on the precautionary principle: we see an illness, respond to it, write a prescription or perform an operation. Social care, however, has traditionally been in the risk business. It involves seeing how far someone can cope on their own, and giving them a bit of support while leaving them in their own home in the community. We are going to have to bring together those two very different ways of working, while maintaining the proper roles of the health care and social care professionals.
	Interestingly, the all-party parliamentary group on social care, which I chair, is undertaking an inquiry into the changing role of the social care profession. That role is changing, but social care professionals want to hang on to what makes their role special. It will be an important job of work for the commission to ensure that it acknowledges that, and that it acknowledges the differences between health care, social care and mental health care, now that they are all within the same remit.
	The commission will have to acknowledge very real differences in another area as well. The NHS is free at the point of delivery, but social care customers pay. They are at the very least assessed to see whether they should pay for most of the services that they receive, and large numbers of them do pay for day care, domiciliary care or residential care. Those paying customers will want their voices to be heard. Concern has already been expressed about how the voice of the user will be listened to by the new commission.
	There is a tension between the Government's understandable desire for light-touch regulation and the need to safeguard vulnerable individuals in health or social care. Sadly, having policies in place is sometimes not enough, because those policies are delivered by fallible individuals. Inspection to see how individuals are applying the policies that we determine is therefore vital. As I understand it, the new commission will have a less frequent inspection regime. Indeed, some social care providers might not see an inspector more than once every three years.
	I listened with interest to an answer that the Secretary of State gave following an intervention on this point. He quite rightly asked why, if someone was doing their job well, we should go round and inspect them every other week. Of course we do not need to do that. However, many social care establishments have a high turnover of staff. I do not have the statistics on health care. A snapshot visit on day one might reveal an excellent care team delivering high quality services, but that does not mean that that same high quality team will still be in place a month, six months or a year later. I wonder how the new commission will be able properly to monitor the huge number of social care establishments that experience a high staff turnover. There is a particular danger involved when senior staff leave, whether the manager of an establishment or a member of the senior team. Those people set the tone for an establishment. They make sure that new staff are trained to work with vulnerable individuals. I hope that the Minister will be able to reassure me that the new commission will look at an appropriate inspection regime for that multiplicity of social care establishments.
	The Bill requires the commission to establish an advisory committee to ensure that it takes into account the views, advice and information coming from people such as providers and users of social care. It should listen to the views of the public on activities within its remit. Again, my question is: how will this work? How will this be achieved in practice?

Sandra Gidley: I am listening with interest to the hon. Lady, and she might be about to raise this point. It is all very well having an overarching group of the great and the good—namely, patients who are known to the system. Does she agree, however, that the benefit of the way in which CSCI has worked has been to ensure that, when an inspection takes place, local views are taken on board?

Joan Humble: I agree with the hon. Lady. I also agree with her earlier remarks about the rights-based approach of CSCI. In my opinion, it is important that that should continue into the new commission. The rights of service users and their carers must be at the heart of the development of the new system of registration and inspection. If they are not, there is a real danger that the voices of people who are reluctant to speak up will not be heard. Patients in hospitals have access to the patient advice and liaison service— PALS—that the Government set up. Those patients are in larger establishments, with more people coming in and out and a larger group of trained staff on hand. Care homes are often small, with a small number of staff and often, sadly, very few visitors, and the people living in them can become isolated. In that context, the voice of the user of those services really must be heard.
	The Bill does not include a requirement for the commission to seek the views of the public. However, two other groups mentioned in the Bill—the office of the health professions adjudicator, in clauses 100 and 101, and the council for healthcare regulatory excellence, in clause 108—are explicitly required to seek public and service user opinions. Perhaps the Government intended the advisory committee to fulfil that role. If that is the case, I would like more information on how the voice of users is to be heard.
	At the risk of overusing the word "vulnerable", I must stress that we are talking about the very vulnerable people who receive these services. I want to mention two groups in particular. Clause 44 will allow the commission to undertake special reviews and investigations. The first group that I want to mention is children with disability. My hon. Friend the Minister might recall that, last year, together with my right hon. Friend the Member for Coatbridge, Chryston and Bellshill (Mr. Clarke), we held a series of parliamentary hearings on the needs of children with disability. One issue that came out clearly from those hearings was the difficulty that many of those children and their families experienced during the transition from children's services to adult services. I hope that the new commission will work closely with Ofsted to see how children's services can be moved forward into adult services in the context of children with disability.
	The second group involves adults with disability, especially adults with learning disabilities. Sadly, we have had too many instances of inequality of treatment of adults with disabilities, in health care and social care.
	The hon. Member for Romsey referred to Cornwall Partnership NHS Trust, which was in a truly shocking state in 2005. The trust had three stars in 2004 and it had two stars in 2005. When it was awarded those stars, was anyone looking at the care on offer? When CSCI and the Healthcare Commission investigated, they described incidents such as
	"staff hitting, pushing, shoving, dragging, kicking, secluding, belittling, mocking, and goading people who used the trust's services".
	The report described a truly appalling situation.
	In March this year, Mencap produced a report, "Death by indifference", which again detailed cases of institutional discrimination within the health service against people with learning disabilities. We really must ensure that the new inspection regime looks at the quality of the care delivered; it should not be just a tick-box regime, behind which examples of unacceptable practice could be hiding.
	The commission will look at how local authorities and other organisations deal with complaints, but it is sometimes by listening to complaints that we find out what is happening on the ground. I hope that the Minister will look at the commission's role and ensure that, in reflecting on how local authorities and individual organisations deal with complaints, it will be able to build up a picture and perhaps identify systemic complaints. If the same organisation receives the same complaints time and again, there may well be something seriously wrong, and the commission needs to be able to identify that.
	About 35 per cent. of people are self-funded in the social care field. They, rather than the local authority, pay for it, so they cannot bring complaints to the local government ombudsman. They have to complain to the person who runs their home. Will they make such complaints if they feel vulnerable within their establishment? If someone else complains on their behalf, how will the new commission find out about it? Again, we are talking about people in isolated settings throughout our communities. A complaints structure provides a good way of building up a profile of when things are going wrong.
	Finally, I want to say a few words on the social care work force, which the all-party parliamentary group on social care is looking into. The General Social Care Council has raised with me questions about its role on the new commission. The GSCC has already registered social workers, but it is rolling out its registration regime. How will it work with the new commission to ensure that people who work in social care are registered, properly trained and have all the necessary qualities to deliver social care to vulnerable groups of people?
	As a newly elected MP several years ago, I recall sitting in the Committee scrutinising the Care Standards Bill. That is one of the best Acts that the Labour Government ever introduced because it addressed the delivery of quality care. If the Bill is to succeed, we must ensure that the new care quality commission will pick up all the good points that were embodied in the Care Standards Act 2000 and ensure that vulnerable people—whether they be in a health care setting or a social care setting—are protected, listened to and supported. That will be the test against which the legislation will be judged.

Peter Bottomley: I hope that the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) will forgive me if I do not follow up all the points that she has presented to the House.
	I start by paying tribute to Peggy and Arthur Wynn. She wrote the first book on family policy in the 1960s. Family policy, or trying to put the family life cycle and family perspective into social and economic policy, has now become a more generally accepted idea. Some people used to think of it as population policy. That is not for us. It can apply to what might be called the private aspects of public health. One of the points that Peggy and Arthur Wynn drew to our attention was the need for pre-conception care, which cannot come from public authorities or commissions.
	Whatever the benefits of having child benefit during the later stages of a pregnancy, the health of the mother can be affected when the father smokes, for example. That can affect rates of birth handicap. Some congenital malformation is perfectly normal, but some can be severe. Some of the severe ones can be affected by the state of the mother's health and the father's behaviour before conception. I believe that we should pay more attention to those issues. We could then add on the sort of provision that the Government are offering through the Bill. It is getting the culture right that matters.
	The French, for example, decided—in the 1960s, I believe—that they wanted to deal with difficulties affecting birth and infancy, so they set out a seven-year programme with various targets that they wanted to achieve. They actually achieved the targets within a year and a half of launching the programme—long before the measures that they had introduced had any chance of having an impact. They were raising awareness and consciousness, and getting people to do more of the things that worked and fewer of the things that did not work. I hope that people will view this debate in the context of trying to get people to do things that are more consistent with what they want for themselves and for those whom they love most.
	We should try to ensure that the early stages of pregnancy get the right degree of attention. I declare an interest, as a member of my family is involved in early-stage pregnancy. Having heard that the Royal Pharmaceutical Society is likely to lose its regulatory impact, I would also like to say that I am the great grandson of the last person—and for all I know, the first person—to be president of the Royal Pharmaceutical Society without being a pharmacist. But that is so far in the past—it was 100 years ago—that it is not relevant now.
	On early-stage pregnancy issues, research will reveal more of what people would want to know, but we already know enough now to be able to say that once someone discovers that they have contributed to conception—this applies as much to the father-to-be as to the mother-to-be—care and concern matter. We want to get away from what could be characterised, probably falsely, as a bipolar approach to pregnancy: too many of us have our conceptions when we do not intend them, when we are very young, and too many of us delay them far too long. We need to get back to the stage of saying that creating a new child is a perfectly normal and natural thing to do and it should not have to be put off until people can afford to buy a house in their 40s—but it should not be done quite so often and so blindly by people in their teens. In effect, we want more people nowadays to make fewer of the mistakes that we ourselves made in our time.
	On the regulation of the professions, I want to declare my general view that it is often easier to make an existing system work better than to have thorough reviews and a thorough all-change. That is not what we are facing. There seems to be reasonably bipartisan agreement that the preparation for the changes in regulation is worth while.
	I back up what the Chairman of the Health Committee said about the civil standard of proof. This is not as big a change or contrast as people have thought. The reason why I raise the matter is that when I served on the Standards and Privileges Committee, we were considering possible offences—and certainly some actions by some of our fellow Members of Parliament—and there seemed to be a general view that the worse the implications of finding someone guilty of bad behaviour, the higher should be the standard of proof. It almost reached the stage where something could not be proved. Just because something cannot be proved, it does not mean that we cannot take action, or that by examining the matter in public at some stage, we cannot get people to understand that someone will say to them, as they would say to me, for example, if I were the person involved, "You've got to do better—get some retraining, or stick to the part of the job you're good at and stay away from the part you're not good at." Only in very rare cases is it found that no one knew what was going wrong.
	I remember some years ago being told by a GP in south London, where we then lived, that his job was to go around saying to other GPs, "Look, you can fight this out in public if you want, but I want to tell you that many of your colleagues don't think you're good enough at what you're doing in this particular area. Please focus on the things that you are good at, where you're making a great contribution." It is not as if people have no right of appeal, or cannot ask for the matter to be examined in a rather more official fashion. It is the same sort of public service that the Whips provide in the House—in a way.
	I also think that we should look for standards of proof of competence, rather than always looking for standards of proof of incompetence. Given the changes that are taking place in, for instance, medicine and sickness care, most people want to demonstrate that they are capable of doing things in a way that has been shown to be better. Obviously an innovative procedure may be challenged. I remember when, 50 or 60 years ago, the "wizard of Wigan" started to provide hip replacements. First it was said that they would not work, and then it was said that even if they did work, no one would be able to afford them. Now I have constituents who are on their fourth or fifth new hip. That is a normal development: we are used to it in many other parts of medicine, and we should allow for such innovations. Keyhole surgery, for example, became a fashion, until people discovered that in many cases it was not being done very well; now it is being done very well indeed.
	I pay tribute to one of my constituents—I suppose that, for reasons of medical confidentiality, I should not name him—who worked on the campaign to save Worthing hospital. Instead of coming to lunch with me today, he had a heart attack yesterday. He was diagnosed and taken to hospital, and had his operation today, with a doctor's balloon up an artery. He is now 100 per cent. fighting fit—or, at least, happy; it will take some time for him to recover fully. Such cases are a result of innovation and professional standards, and I pay tribute to the doctors, nurses and others who cared for my constituent. Lunch could be postponed but the operation could not, and I am glad that Worthing hospital was still there to provide it
	Clause 119 has received no attention so far. Obviously Second Reading is not the time to go into great detail, but Liberty has contributed a useful thought about the provision for a magistrate to exercise major power, suggesting that except in emergencies a magistrates court, rather than just a single magistrate, should be involved. Perhaps the issue could be dealt with in Committee. When a magistrate signs a detention order—which is only one of the powers available to him—it may be challenged, although on many occasions it will be accepted. If the order is challenged, could it not be put to the magistrates court for confirmation?
	Perhaps on Report, when the Committee has had a chance to consider the matter, we could have a fuller debate on whether Liberty's point should be followed up, or at least adapted. Clearly the power to detain someone with an infectious condition or for failing to accept treatment, or for some other reason, is necessary, but I do not think that the provision should automatically be passed because of other issues of regulation. If a person's liberty could be at issue, we ought at some stage to engage in a full and open debate on the Floor of the House—for the protection of the public, if not for that of the person concerned—and it would seem appropriate to do so on Report.
	Clause 41 states that the Secretary of State must consult before making regulations. The people whom he consults will be chosen by the Secretary of State himself. That raises a point of trust. I think that whoever holds the office of Secretary of State—and it is a matter of public record that I am married to someone who once held that office—we ought to be able to trust that person and his or her advisers. We should resist the temptation to throw a few jokes around, and say that while Secretaries of State and their advisers may not necessarily be perfect, they ought to be able to run a system allowing open and genuine consultation before the laying of regulations. The public ought to be aware of the points that are made, and the Secretary of State should have to defend the decisions that are eventually made. However, I cannot claim that the system always works.
	I end by paying tribute to the Health Committee. I attended its first hearing on Modernising Medical Careers and the medical training application service. The officials who gave evidence made an opening statement that allowed the tone of the meeting to be far more useful than it might have been otherwise. However, we need to know at some stage how so many people became involved, and why the outcome was—I am using very gentle language here—so inappropriate.

David Taylor: I want to speak about the establishment of citizens councils for the regulation of health care professionals.
	Anyone who reads the Bill will recognise immediately the difficulty experienced routinely by members of the public who seek to decode important issues requiring public scrutiny and debate, and the parts relating to the long-overdue modernisation of professional regulation are no exception. It is that small yet significant part of the Bill that I want to discuss. The co-operative movement, of which I am a tiny part, is perpetually renewed in each generation when aspects of it become more relevant to current issues and dilemmas. Our task is to put it in a contemporary context, which is what I have done in early-day motion 386, tabled today, concerning the establishment of citizens councils for the regulation of health care professionals.
	Co-operation and partnership working between citizens and professionals is even more essential in health care today if we are to regain the trust and confidence of the electorate and service users, and their belief that the decisions made give them the rights, dignity and patient safety that they deserve. I extend the famous Putney debate principle that
	"The poorest he that is in England hath a life to live as the greatest he"
	to the context of devolution, and the importance of achieving an effective United Kingdom-wide system ensuring patient safety and the best possible patient experience across the 2 million people working in the health care sector.
	I do not know whether Members saw an edition of the  Daily Mail, published in February 2006, whose front-page headline read "Sentenced to die by arrogance". It reported that 18 patients had been wrongly given a breast cancer screening all-clear by a consultant radiologist, who had continued to work for 18 months before the employer launched an investigation. The case was then referred to the General Medical Council.
	The allegations will sound familiar: a practitioner working in isolation, absence of monitoring of work practice, colleagues not speaking up strongly, and a health trust reluctant to intervene. The public are also familiar with recent cases in which patients have been abused and died. Failures of paediatric surgery in Bristol, and the conviction of GP Harold Shipman for murder, provoked high-profile and expensive Government-sponsored inquiries.
	However, this is not just about doctors. Nurses and midwives, dentists, pharmacists and many more have their own regulatory bodies, and the Health Professions Council regulates as many as 13 professions, with more in the queue. Nor—as we have heard in today's debate—is professional regulation concerned solely with striking people off registers and barring them from further practice. The nine statutory professional bodies are responsible for setting the standards that practitioners must meet in their education and daily practice.
	We must ask ourselves what patient and public involvement can add to regulation. If regulation is to be undertaken in the public interest, it must also require public involvement. The regulation of professionals, argued Sir Ian Kennedy in his 2001 report "Learning from Bristol", is too important to be left to the professions. He said:
	"The public are entitled to be involved at all levels and stages: in both setting and agreeing the systems for assuring competence and in their operation."
	The report went on to explain why that should be so:
	"First, the public can participate in the process of setting and reviewing the criteria for admission to the profession.... After all, the professional is going to be caring for the public as patients.
	Secondly, public participation in this process serves as a warranty that the public's interests are being safeguarded and as a reminder that the profession exists for the public".
	In 1999, the National Consumer Council took an outsider's look at professional regulation, questioning whether it was fit for the fundamental purpose of protecting the public. It found a confusing patchwork of procedures, terminology and standards for the different professions, and pronounced the system to be out of touch with the times. The Bill gives us a once-in-a-generation opportunity to modernise professional health care regulation for the benefit of future generations.
	The challenges that patient and public groups have raised about the direction of change—system complexity, the lack of transparency and clarity in processes, and the failure to join up complaints and redress systems—remain with us, and measures in the Bill are intended to address those issues. However, the modernisation of professional health care regulation requires a much more dynamic approach to public and patient engagement than is set out in paragraphs 1.11 to 1.27 of "Trust, Assurance and Safety—The Regulation of Health Professionals in the 21st Century" and in the Bill.
	The general public do not necessarily know much about regulation, but they assume wrongly—and fondly, perhaps—that there are robust systems for ensuring that practitioners are competent and up to date. That is a reasonable expectation, which Government must ensure is met. In 2005, the Department of Health commissioned a research study from MORI to examine the attitudes of the general public and doctors towards medical regulation and assessment. The key findings of the research are worth highlighting. It was found that few members of the general public know anything about the current system of assessment of doctors after qualification. Almost half of the sample of the general public assume that regular assessments are already taking place, with more than one in five thinking they already happen annually.
	There is widespread support for regular assessment among both the general public and doctors. Nine in 10 members of the public and more than seven in 10 doctors thought it important that doctors' competence be assessed every few years. Nearly half of the public thought that those assessments should be done on an annual basis, while doctors favoured doing it less frequently; interestingly however, hospital doctors seem to favour more frequent assessments than their colleagues in general practice.
	The current system of medical regulation is not visible to the general public. It is striking that many people believe that regular assessment of doctors is already taking place. Moreover, almost all wished it to take place frequently, and half said that there should be annual checks. That public view is in marked contrast to that of commentators and politicians, who often hold that regulation should be a "light-touch" process—a view not necessarily shared by patients in the United Kingdom.
	Changing traditional professional attitudes requires an informed public, who have an important part to play in co-producing public safety and improving the overall patient experience. That cannot be effectively achieved by the separate PPI—patient and public involvement—arrangements financed by different regulators within the health care team. I hope that the Minister will respond to the fact that the Bill proposes that lay membership of the Council for Healthcare Regulatory Excellence be reduced from 10 to seven people and be appointed to "reflect"—whatever that might mean—rather than to represent, an increasingly diverse public.
	The CHRE, which is in practice more accountable to Government than to Parliament, would in my view greatly benefit from independent citizens councils that are representative of, and accountable to, diverse community interests in each part of the UK. I have today tabled early-day motion 386 because we need to recognise the difficulties that patient and public groups face in finding the resources to engage in detail with the complex and intricate processes of balancing professional and public interests. New citizens councils should be established in each of the four countries of the UK to work alongside the CHRE. The essence of democracy is that it makes it possible—I emphasise the word "possible"—for a diverse public and patient view to express itself.
	The citizens council idea is not new. As specified in the English NHS plan in 2000, the National Institute for Health and Clinical Excellence has valued its citizens' council and has referred to it in positive terms on numerous occasions. There is learning to be had and examples of how it might work in the many citizens juries that have met, and in the national debates that have been conducted in fields such as health, environmental issues, urban planning and genetically modified foods. In the context of health care professional regulation, citizens councils should be independent—and should be seen to be independent—and should be funded from the public purse, in order to explain to, and inform, interested and diverse patient and public groups about the nature and significance of proposed changes to the system of professional health care regulation, carry out consultations and collate responses on a four-country-wide basis.
	I stress the importance of lifting this debate out of the technical language in which the dialogue is currently conducted. We should give a real chance for a public perspective to be heard and taken into account, alongside that of the very well-organised and well-financed professions that are constantly lobbying and fully engaged in promoting substantial legislative change, both in terms of this Bill and, as my right hon. Friend the Member for Rother Valley (Mr. Barron) mentioned, through section 60 orders under the Health Act 1999. I believe that one has been tabled today.
	Let me finally turn to the subject of health care support workers. There is concern that pressing issues for patients and the public—such as the effective regulation of those who give hands-on care to vulnerable population groups in hospitals, nursing and residential homes and in the community, often involving intimate and personal care in health-care assistant roles—are not being treated with the urgency that they deserve, although such workers are increasingly important in the context of community-based provision.
	Those concerns include the lack of education and training for tasks traditionally carried out by qualified, registered health care professionals and the lack of a regulatory framework for health care support workers. Responsibility and accountability for their actions in clinical and other settings cannot continue to be considered behind closed doors, and active public engagement is required. Citizens councils provide the mechanism to make this a reality. I hope that the Minister will respond specifically to that point.
	There is common ground among the main political parties; I hear that there is unlikely to be a Division tonight. We are all seeking to find ways of securing democratic renewal and engaging citizens in hard decisions, addressing risks, balancing rights and deciding on priorities for Government action at UK and devolved levels. Although they are invisible to the public—we must ask why—professional health care regulation and the regulation of health care support workers are key areas in which it could be demonstrated that bodies such as citizens councils can work and make a difference. However, the Government also need, jointly, to put in place a structured system, which is inclusive and ensures that a wider perspective is brought to the debate, alongside the CHRE's inevitably close working relationship with professional health care regulatory bodies.
	The Minister needs no sympathy from me, but it is true that Ministers have an unenviable task in this respect. They have to cope with the intricacies of separate legislation and the complexity of a UK-wide system. They will face—they are already facing—strong professional lobbying, and objections to ending elected member representation will undoubtedly be one theme. Another theme has been the standard of proof in fitness to practise proceedings under part 2 of the Bill. At its heart, however, the issue they face is very simple. The public expectation of health professional regulation is that it will deliver health professionals who can be trusted to provide up-to-date relevant treatment and therapies, who are dedicated to developing their knowledge base, and who have patient safety as their overriding objective.
	When things go wrong, people expect a full explanation, and perhaps recompense, but more often changes that will reassure them that the situation is unlikely to occur again. Root-and-branch reform was the demand from some of the patient-focused organisations that responded to the White Paper consultation. The MORI polls that I mentioned earlier showed that people assume that regular checks on health professionals are already in place, and that policy is much further along that road than it actually is. Failure to take decisive action now threatens to destroy public confidence, not only in regulation, but also in the policy process itself.
	In summary, public engagement can help drive the co-production of modernised professional health care regulation, especially in relation to secondary legislation, in the period to 2011. I urge the Minister to take on board my comments, and I hope that the Government will introduce citizens councils, so as independently to inform the CHRE's strategic decision making and strengthen a four-country approach to patient safety and improvement of the overall patient—or service-user—experience.

Stephen Crabb: It has been a privilege to attend the debate. There have been numerous thoughtful contributions from experienced and knowledgeable Members, and it is a pleasure to follow them.
	As suggested by my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) in his response to the Secretary of State's address, one could have been forgiven for thinking that the first health Bill under a new Labour Prime Minister would be a bold attempt to set a groundbreaking agenda for the health service—that most iconic yet troubled of our public services. In recent months, we have heard some expansive, and at times not unattractive, rhetoric from Health Ministers about tackling health inequalities and the importance of the public health agenda, but I am afraid that the measures in the Bill do not back up that rhetoric and provide little confidence to suggest that the Prime Minister and his Ministers have a serious and compelling long-term vision for our health services.
	There is considerable agreement in all parts of the House on the Bill's broad policy objectives, but I want to address an issue on which there is room for some contention—indeed, it has been commented on already today—the health in pregnancy grant. The notion that pregnant mothers might need assistance in making choices about their diet and lifestyle in order to give their babies the very best start in life is absolutely unobjectionable. In an age of increasing obesity, and yet a wider and deeper knowledge about the importance of good diet in pregnancy, no one would disagree with recognising that the state can play a positive role in supporting pregnant women and helping them to eat the very best food. It is, Mr. Deputy Speaker, literally motherhood and apple pie.
	However, it is a huge leap from that position to supporting a one-off cash payment being made to all mothers, regardless of socio-economic background or geographical location—there are differences in health outcomes and diet that are related to the geography of the UK—at a fairly late stage in their pregnancy. It is a huge leap from endorsing the general principle of supporting pregnant women in making healthy lifestyle choices, to supporting a one-off cash payment at a late stage.

Howard Stoate: I understand the hon. Gentleman's reservations about the late payment of a one-off grant, but can he come up with a scheme that would work better and really get to all such women, regardless of their circumstances, and not just those who apply for a grant, in order to ensure the widest possible uptake?

Stephen Crabb: I will go into this issue in a little more detail shortly, but where is the evidence to suggest that absolutely all women need assistance from the state in making good choices about their diet and lifestyle in pregnancy? Surely the priority should be targeting limited resources on those in most need. The evidence to suggest that such a crude, untargeted payment after the 25th week of pregnancy will lead to better dietary choices on the part of mothers, and therefore to better health outcomes for babies, is simply non-existent.

Greg Mulholland: Perhaps I can help the hon. Gentleman by asking whether he agrees that we should have strict conditionality regarding what this enormous sum of money is spent on, to ensure that it is spent on what it is supposed to be spent on.

Stephen Crabb: We can look at conditionality, and at alternatives to how this money might be spent that achieve similar outcomes. Where are the results of the pilot and the pathfinder studies to back up these policy proposals? Were any lessons drawn from international experience to suggest that such a one-off lump sum payment can deliver the policy objectives that we want to see?

Kevin Barron: Is there not clear evidence that universal state benefits get to people, and that those that have to be applied for do not?

Stephen Crabb: I am not disagreeing with that—there is no doubt that the cash will get to people. My argument concerns how the cash will be used and whether it will actually deliver the health outcomes that Ministers are saying it will.
	I turn to the timing issue and why there is this focus on such a late stage of pregnancy—the 25th week. That approach conflicts with a lot of expert opinion and practical wisdom out there regarding ensuring the well-being of a pregnant woman for the whole term of her pregnancy. Tam Fry, director of the Child Growth Foundation, was quoted in  The Observer when this policy was announced as saying:
	"By the time a woman falls pregnant, she already needs to be eating well".
	Daghni Rajasingam, speaking on behalf of the Royal College of Obstetricians and Gynaecologists, said at the time:
	"If a woman is not already eating a healthy diet by that stage"—
	the 25th week—
	"then encouraging them to eat more fruit and vegetables"
	from 25 weeks
	"is too late...Even for small babies it is too late, there is very little you can do to increase growth at that stage."
	So the emphasis on the 25th week is entirely misplaced. The Government should be stressing the need for pregnant women to learn good lifestyle and well-being habits and to unlearn some bad habits, such as those related to smoking and alcohol, at the earlier stages of pregnancy.
	I do not remember much of my National Childbirth Trust classes before my first child was born, but I do remember two things. I remember the women being separated from the boyfriends and husbands at the very first meeting, and the men being put to one side and given a game to play. We were given a diagram of a female body and about 25 labels, and we were asked whether, as a group, we could label a woman's body correctly. I think that we scored under 75 per cent., which suggests that men should tread carefully when talking about such issues. I also remember the emphasis that was put at the very outset of those classes on the importance of diet and good lifestyle. There was no discussion of the 25th week and of getting one's act together at a late stage of pregnancy; the focus was always on sorting out the issues—giving up smoking, cutting down on alcohol, watching what one eats and eating good quantities of fruit and vegetables each week—from the very start. So the focus on 25 weeks is misplaced.
	I want in a very gentle way to raise with the Minister a question that is not purely hypothetical. There is some discussion in all parts of the House of the termination of pregnancies at this time, and whether there is a need to look again at the upper-term limit and to reduce it. What would happen if, the two Houses in this Parliament being willing, the upper-term limit were reduced to, say, 22 weeks? Would there be a need, therefore, to move the timing of the cash payment back, in line with that? If not, in theory a pregnant woman could legally make a claim for the grant and also legally terminate a pregnancy. I am talking very hypothetically, but I would welcome a response from the Minister because termination limits is a live discussion.
	The hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) spoke about the meeting with a health professional that a pregnant woman would need to have in order to claim this grant. I share her vision of how that would work in practice. She talked about an ongoing dialogue involving giving advice to pregnant women about diet and lifestyle choices, for example. However and as I said in an intervention, the Bill, which is vague on detail, does not provide for that. Rather, it refers to a woman receiving
	"advice on matters relating to maternal health from a health professional".
	She will have had that, anyway, from her health visitor or GP, so I do not see how we get from the Bill to the idea put forward by the hon. Lady, which I support, of an ongoing interface between the pregnant woman and a medical professional about diet and healthy choices.
	I turn to how the scheme will be administered. We know that it will be delivered through Her Majesty's Revenue and Customs—this huge, sprawling, merged Department that, as we now know, is beset with operational difficulties. If we did not need any other reminders, the events of last week have shown that yet again. However, there is another experience involving HMRC that is relevant here—that of tax credits. We all know from our constituency surgeries the number of people who are having to pay back money that the Treasury is clawing back as a result of overpayments. We know that when many people are given up-front payments, they spend them—that is in the nature of things. Those on low incomes or facing pressing expenditure needs, in particular, will spend them. Where is the evidence to suggest that a pregnant woman will use this one-off cash payment of the health in pregnancy grant in a planned way to meet their ongoing dietary needs and to ensure that they can pay for good-quality fresh fruit and vegetables? Will not human instinct take over if this money is paid in a one-off lump sum? The Secretary of State has talked outside this Chamber about the "broccoli police", who will not be coming round to check that all the money is being spent on what it is intended for. However, it is worth asking whether this money will just get burned up very quickly and will not be used in the way that Ministers intended.
	To conclude on this point, the Government are proposing to spend a significant sum—£120 million—and if one accepts the line from the Royal College of Midwives, that figure will increase significantly in the years to come. In the absence of any effective strategy for well-being during pregnancy or any prioritisation in respect of poorer women or women from areas where there is a higher incidence of diet-related problems, and when the maternity services of many communities are being eroded, could the money be put to better use? To my eyes, this is more part of a political strategy than a health one, and to many people it smacks of the Government trying to create a new tier and category of cash-receiving clients of central Government. There is room for contention and vigorous debate on this measure.
	On the national child measurement programme, the hon. Member for Caernarfon (Hywel Williams) knows that I am not the greatest devolutionist in this place, but I support the measures in the Bill to extend powers to Ministers in the National Assembly for Wales to introduce a similar scheme in Wales to the one that has been running in England and to bring it in line with the changes that will be introduced in England for measuring the height and weight of children with a view to feeding the information into body mass index calculations.
	Wales has a significant and growing problem of childhood obesity. It is not a new phenomenon. Ten years ago, groups of general practitioners in Wales were warning that an epidemic of childhood obesity was about to hit Wales. In the past eight years, since the establishment of the National Assembly for Wales, which has responsibility for these issues, precious little substantive action has been taken to tackle childhood obesity in Wales. I welcome this measure in the Bill. If it enables, and provides more tools to, Health Ministers in the Assembly to tackle childhood obesity, it has my support.
	I was excited to see the small section on social enterprise in the Bill. Some years before being elected to this place, I was involved in setting up a social enterprise in south London. It was attached to a large mental health charity working with people from the African and Caribbean communities. The idea was to create a social enterprise using some of this charity's clients in producing high quality frozen African and Caribbean food to sell to national health service primary care trusts, which were demanding such food as they moved towards having more ethnic choice in the meals that they provided. We faced huge hurdles in setting up the social enterprise. Trying to do business with PCTs, get contracts and negotiate all the different hurdles that we had to clear was a time-consuming and expensive process. We benefited from the fact that a PCT supported what we were trying to do, shared the vision of the social enterprise and put its resources behind it.
	If, as I understand it, the measures in the Bill will extend such provision, give more direction to it and enable far more social enterprises to crop up in the health and social care field, that can only be a good thing, because this is a rich environment for social enterprises. It would be good to hear from Ministers about their vision for social enterprise and how it can contribute to health and social care.

Howard Stoate: As the House well knows, I still do some general practice for the national health service and I have a particular interest in public health. As we have heard this afternoon, one of the most serious public health issues facing this country is obesity, which is not only growing at an extraordinary and alarming rate, but is one of the most difficult areas to tackle.
	The Foresight report, published on 17 October, set out some alarming statistics, and I want to focus on the part of the Bill that deals with the weighing and measuring of children. The report said that in 2004 approximately 10 per cent. of boys and girls aged six to 10 were obese, but the forecasts were rather more alarming. The report pointed out that those figures are likely to increase to 21 per cent. for boys and 14 per cent. for girls by 2025, and to 35 per cent. for boys and 20 per cent. for girls by 2050. Those figures are probably conservative, because they are based on an international standard for measuring obesity that we do not use in this country and which, if anything, underestimates the prevalence of the problem.
	The national child measurement programme records the height and weight of children in reception and in year 6, and at least gives us some information to go on. The national public health service was recently asked by Government to undertake a feasibility study in 2007-08 on the creation of a national surveillance programme of children's height and weight. Again, that goes some way towards addressing things. The provision in the Bill for weighing and measuring children is buried in the miscellaneous provisions in part 5. I call on the Government to go much further, both from the health point of view and in ensuring much more cross-departmental work in government to try to tackle this issue.
	There is no question but that the provision of better information and advice to parents about their children's health is essential. The majority of parents probably are well aware of the growing incidence of obesity and the need to tackle it, but parents do not always identify problems with their own children. As a general practitioner, I frequently see parents who either are not aware that their children are obese or have little idea how to tackle the situation. It is alarming to note that some parents still say that their children have puppy fat, that they will grow out of it because it is just a phase, that it is because of the hormones or that it will be okay. Unfortunately, that is not the case, and more often than not obese children become obese adults.
	Without question better surveillance is needed, but that will take us only so far. Although as individuals we are responsible for our bodies and our health, our freedom to act is often constrained by the nature of our built environment. That is why I want work to be done much more closely with other Departments and across government. Not only our built environment, but our income, our access to transport, the nature of local retail markets and a myriad our social and economic circumstances all come to bear on this issue.
	A parent may be fully aware that their child is at risk of becoming obese and they may be fully committed to preventing that from happening or to tackling it, but if they live in a house that is separated from the nearest park by a busy road, or they are reliant on local convenience stores that sell energy-rich food but do not necessarily sell much fresh food, their ability to sort out their child's obesity problem is limited.
	As a consequence, the state, as Lord Krebs made clear in his excellent foreword to the recent Nuffield Council on Bioethics report on public health, has an ethical responsibility to intervene and remove the constraints limiting one's ability to live a healthy life. In that sense, state intervention should be seen as a means of empowering individuals and of maximising their freedom to live a healthy life rather than, as some critics tend to say, as an unwarranted state interference in people's lives.
	What form of intervention should the state undertake? The Government need to consider a range of supply side issues. Educating children about healthy eating and healthy living in school together with infrastructural measures aimed at enabling people to undertake more physical activity are obvious supply side factors. Other, more contentious interventions, such as a complete ban on the advertising of food and drink products that are high in salt, fat and sugar during TV programmes are justifiable. A complete ban will give children—the most vulnerable members of society—the freedom to make informed choices for themselves based on information on healthy living that they receive from schools rather than on undue influence from food and drink manufacturers.
	Providing people with the opportunity to develop the necessary life skills and the right resources to live healthily is not necessarily enough in itself to deliver a meaningful reduction in overall obesity levels. People often have the necessary motivation to live healthily and possess the necessary skills to do so, but unless they live or work in an environment where there is an established culture of living healthily, there is a good chance that they will never be able to reach their goals. If a community is dominated by people in full-time employment who drive to work each day at 8 am and close their front door when they return home at 6 pm, as happens in many communities, simply providing better sporting facilities and more opportunities will not be enough to change people's habits. The chances are that if our family, friends, neighbours and peers do not exercise, we will not either.
	What can we do about that? In order to achieve a paradigm shift in society, public health policymakers around the world are increasingly experimenting with social marketing strategies aimed first at marginalising antisocial, unhealthy behaviour and secondly at embedding healthy behaviour in the fabric of people's everyday lives. They would argue that until an activity becomes a normative behaviour and is firmly entrenched in people's lives, so much so that they do it as a matter of course, we cannot judge a policy intervention to be a success.
	Smoking is a prime example of that. Whereas once it was seen as an unremarkable practice, or occasionally even as a socially desirable one, in many public areas smoking is now a marginalised activity—in public spaces it is illegal. We need to take a similar approach on physical activity. That is particularly important at school level where for a child to be seen as fitting in and making sure that they do not miss out on something is of paramount importance to their sense of well-being.
	We have to turn that herd instinct to our advantage. Instead of its being socially desirable to be driven to school and socially undesirable or abnormal to walk, we have to try to turn that perception on its head. It is perfectly possible, for instance, to imagine children insisting that they be allowed to join the walking bus to school because that is where all their friends are and where all the social intercourse takes place. Children who are driven to school could feel that they are missing out on an essential part of their upbringing. If we can change the children's perception in that way, we will see a genuine shift in behaviour. If that becomes a normal way to travel to school, parents will also be less concerned about the obvious potential dangers of walking.
	I can see similar examples all over my constituency. People are social beings. We follow the crowd. We ignore empty restaurants and go to full ones. We do not sit down on an empty bench in an empty park because that looks odd, so instead we go to busy parks and sit on benches where other people are sitting. Huge amounts have been spent to create new public spaces in my constituency, but little thought has been given to how they will be used. It is pointless to create them if they do not deliver. Concerns about security, blind spots, lighting and the possible presence of antisocial users mean that normal people tend to avoid such spaces—except on special occasions when an organised event takes place.
	The problem is that when we plan and construct our built environment and leisure spaces, we do not think enough about how—or indeed whether—they will be used by the people they have been created for. Or alternatively, we make assumptions about how they will be used without actually going to the trouble of asking potential users what they want. In many cases, that is because of time and cost issues. A developer will often choose an off-the-peg design because it is the easiest thing to do, and keep stakeholder consultation to a bare minimum, because that can also be difficult. Involving the local planning authority also saves time and avoids expense.
	Because bad design is so rarely challenged—and almost never on public health grounds—highly questionable design principles that have never been properly tested become established design conventions that continue to be followed by planners, developers and designers, because that is the way that things have always been done. Consequently, the majority of new developments that are built in this country contain vast areas of unused, unloved, badly planned, dead public space. Only the roads are used regularly. The cumulative cost of those mistakes in social, economic and health terms is colossal. We can and must do something about that.
	In many cases it will mean sweeping our established design principles off the table and engaging with users at the very start of the design process, rather than seeing the consultation process as merely a tick-box exercise. Public health professionals also need to be engaged in a meaningful way from the start, rather than simply being invited to comment on established plans. That is blue-sky thinking and it will certainly be more expensive, but if it helps to produce a happier, healthier, more active and socially engaged community in the long term, the savings will more than outweigh the initial costs. I hope that during the Bill's passage we will be able to envisage, and possible even enshrine in the legislation, how cross-departmental government could deliver some of those aims.
	Another issue in which I have an interest, as chair of the all-party parliamentary pharmacy group, is pharmaceutical services. The hon. Member for Romsey (Sandra Gidley) has already laid out some of the concerns of some pharmacists about the change in regulations, and I echo what she said.

Stephen O'Brien: I wish to help the hon. Gentleman out. He rightly declared his interest as a practising medical practitioner at the outset of his speech, but before he addresses the issue of pharmacy, he might wish to remind the House of his entry on the Register of Members' Interests concerning overseas visits.

Howard Stoate: I certainly refer anyone who is interested to the register. I have been on pharmacy-funded trips in the past to take part in international debates and they are registered fully.
	There are concerns about the global sum being transferred straight to PCT budgets. Although the Pharmaceutical Services Negotiating Committee has welcomed the creation of a single funding stream as a means of simplifying funding arrangements, many pharmacists and pharmacy organisations have one or two concerns. Those include whether in times of financial difficulty the PCT might be able to move money away from pharmacy services to other services if it felt that that was necessary. That would be regrettable and, with pharmacists doing more and more clinical work—and being asked to engage more in front-line clinical services—there should be some way to ensure that money given to PCTs through the global sum is protected to ensure that it does not happen.
	The hon. Lady also mentioned the new regulatory procedures. The Royal Pharmaceutical Society wants confirmation that the transition to a new regulator will be managed properly, will be adequately funded and will utilise the unrivalled experience of many individuals and organisations that play an important role in pharmacy. I ask the Minister to ensure that the process includes full consultation with the profession and all stakeholders in pharmacy.

Richard Taylor: I am pleased to follow the hon. Member for Dartford (Dr. Stoate), who is the only practising member of the medical profession in the House. I congratulate him on his speed of delivery, which means that he gets through a vast amount in a short time, which is very welcome. I cannot promise to go as fast, but I shall not take much longer.
	I shall confine my remarks to parts 1 and 5 of the Bill. I shall not touch on the public health issues in part 3, because they are widely welcomed, nor on the regulation of the professions in part 2, because it has been widely covered and some of my concerns raised. Even though I am retired, I am still perhaps a little too close to the profession to avoid being accused of partisanship.
	Part 1 relates to regulation of health care organisations and the formation of the care quality commission. I have long been in favour of bringing together health care, social care and mental health care, so that is a welcome move. However, I have several worries. The first is that it is a huge task for one organisation to undertake. I am worried about the financial backing, the personnel and whether the resources will be available to make the body fully efficient. Secondly, the Bill is short on listing the actual duties of the new commission. The Picker Institute has produced a valuable briefing on the Bill, which states:
	"The Picker Institute believes the principal duty of the regulator should be to promote the interests of patients, service users and the public with regard to the quality and safety of care services."
	That is vital. The Secretary of State used the words "safety" and "quality of care" in his introduction, and the commission must satisfy those requirements.
	I am also concerned about patient and public involvement. The Picker Institute suggests a user panel. The hon. Member for North-West Leicestershire (David Taylor) mentioned a citizens council and the hon. Member for South Cambridgeshire (Mr. Lansley) was worried about the lack of a formal structure for patient and public involvement. Why is there no mention in the Bill of Local Involvement Networks—LINks—the organisation designed by the Government to take over from the community health councils and the patient forums that they abolished? LINks is the one body made up of ordinary individuals, patients and citizens that can translate their feelings to a regulating body. LINks should be at the heart of assessments of the quality and safety of care. It represents patients, and the NHS belongs to patients, so it is inexplicable that LINks is not mentioned in the Bill—I may have missed it, although I looked carefully.

Ben Bradshaw: The simple reason is that LINks is already established under previous legislation. I am happy to talk about it at great length, but it is not required to be covered in the Bill.

Richard Taylor: I thank the Minister for that intervention, but although we do not need to establish LINks, there should have been some acknowledgement in the Bill of its presence and importance.
	LINks is in trouble over TUPE—the Transfer of Undertakings (Protection of Employment) Regulations 1981. It is not yet clear whether TUPE applies to staff in the Commission for Patient and Public Involvement in Health, who badly need to know about that issue before the commission is abolished. A letter to the Department of Health from the CPPIH asks two crucial questions, which I press the Minister to answer; even if he cannot not do so now, he should do so fairly soon, because the matter is urgent. The commission asks the Department to
	"Provide its opinion on whether TUPE is likely to apply"
	and
	"Give explicit instruction to the CPPIH regarding the risks associated with TUPE and current redundancy plans".
	If those points are not clarified by the time the commission is abolished it may run up a huge bill that it will be unable to pay.
	My final point about part 1 relates to the Healthcare Commission and problems with the NHS complaints procedure that have been mentioned by other Members. The complaints process must be independent and fair, but with the removal of the commission from it we shall lose the automatic involvement of independent experts. In a complaint, especially where there are clinical problems, the involvement of knowledgeable, independent clinical specialists is essential.

Stephen O'Brien: The hon. Gentleman makes a powerful point about something that, as he knows, goes back a full eight years to the appalling loss of community health councils when they were summarily axed in England. CHCs were the one place where a complainant could be confident that there was an independent person to hold their hand and help them. That independence was important, as he says.

Richard Taylor: I thank the hon. Gentleman for that intervention. Independence is crucial. That obligatory independence will be lost in the complaints process that will result from the removal of the Healthcare Commission. It will be left to people in an internal complaints process to decide whether to include an independent view. Will they want to do so? Of course not. That is a huge weakness in the proposals. The hon. Member for Pendle (Mr. Prentice) pointed out that there would be a tremendous increase in the number of cases taken to the ombudsman. In a briefing, Age Concern noted that there could be a massive increase in the ombudsman's load if the proposals go ahead. I strongly press the Minister to write some independence into the proposed complaints procedure.
	My final points relate to part 5. What may for me be the most important clause in the Bill has not yet been mentioned: clause 129, "Duty of Primary Care Trusts", which deals with the arrangements for improving the quality of health care. It reveals that for the last six years, since I have been a Member, I have been taking entirely the wrong approach to complaints. I have been tackling providers about the service that they provide, but clause 129 indicates that I should have been tackling the commissioners because they have the right to remove the service.
	In the Queen's Speech debate on health, I described some of the appalling things that were happening in my patch and in others. Not long ago, I had a meeting with the chief executive and the chair of our primary care trust and I was encouraged. Even at that stage, the chair had received many complaints about the quality of care and was beginning to realise that it was the duty of the PCT as commissioner to point out the problems and try to get them rectified. I am pleased that clause 129 is in the Bill; it is short but it must not be lost, because it is crucial.
	Clauses 132 and 133 relate to the weighing and measuring of children in England and Wales. Obesity in children has been mentioned by the hon. Member for Dartford, at length, and by the hon. Member for Romsey (Sandra Gidley). The Select Committee on Health held an inquiry into obesity in 2003-04. Recommendation 45 stated:
	"We recommend that throughout their time at school, children should have their Body Mass Index measured annually at school, perhaps by the school nurse, a health visitor, or other appropriate health professional. The results should be sent home in confidence to their parents, together with, where appropriate, advice on lifestyle, follow-up."
	At the time, we were slightly attacked as it was thought our proposals would stigmatise obese children. I did not think that argument had any force at all because there was evidence that parents were unaware that their children had a problem.
	The importance of public health issues, especially obesity, has been recognised for a long time. Public health came to the fore in the 1880s with the great recognition that bacteria caused disease. As time is not at an absolute premium, I should like to remind the House of Sir Walter Scott's words in the novel "The Surgeon's Daughter", published in the 1820s. He bemoaned the poor recompense for a Scottish village doctor compared with his English counterpart:
	"The burgesses of a Scottish borough are rendered by their limited means of luxury, inaccessible to gout, surfeits and all the comfortable chronic diseases which are attendant on wealth and indolence.
	There the mothers of the state never make a point of pouring, in the course of every revolving year, a certain quantity of doctors' stuff through the bowels of their beloved children."
	As long ago as 1820, the problems of idleness and affluence were recognised. I do not say that we should return to poverty, but I welcome the Bill's emphasis on public health, especially the measures aimed at spotting overweight children—not to stigmatise them, but to tackle the problem.

Charles Walker: I am grateful to be called to speak in this incredibly well attended debate.
	When I heard that there was to be a debate on health I had intended to talk about my constituency, to tell the House that it is important that Cheshunt gets an urgent care centre when the PCT reports back in a couple of weeks' time. I had planned to tell the House what a wonderful job my council has done in supporting health service infrastructure in Broxbourne—and long may that continue. However, I am not going to do that, because it has absolutely nothing to do with the Bill. It would be totally gratuitous of me to use this opportunity to get those things off my chest.
	I would particularly like to focus on the work of the care quality commission. In my constituency, there is a growing loss of confidence in the NHS and in hospital care among sections of the people whom I represent. The NHS still provides high levels of service to the vast majority of patients, but over the past few years there has been an increase in hospital-borne and hospital-acquired infections. That is causing unease, and it is causing some to be fearful of being admitted to hospital. It is important to address those fears, because hospital is a place where people should go to get well. It is a place that puts people back on their feet, but if well-meaning people start to fear going to hospital, that will undermine confidence in the NHS, which will be to the detriment of us all.
	Over the past few years, there have been a number of well-publicised—I will not call them disasters—very unfortunate events that have led to people dying unnecessarily. They occurred at Tameside in Manchester, and there have been problems with C. difficile at Stoke Mandeville, and most recently at Maidstone. I am trying to understand how we in this country have got to the position in which people die in hospital from diseases that are preventable. I admit that some bugs are developing resistance to antibiotics and other treatments, but the idea that people go to hospital and fall ill and die from disease is extremely worrying. I am trying to understand why the growth in the number of such illnesses has occurred over the past few years. The issue is important in the context of the care quality commission and its work in trying to identify the problem, disassemble it and then come up with solutions that actually work.
	When I am canvassing in my constituency, I talk to a lot of people who work at Chase Farm hospital. As you may know, Mr. Deputy Speaker, the hospital faces a fairly rocky and uncertain future and I am met on the doorstep by nurses and orderlies who are often in tears when I speak to them about what is going on in their hospital and its future. They tell me about low morale, that people do not know whether they will have a job in a year's time and that it is difficult to recruit. They tell me about a lack of pride in the place, which is very worrying when set next to the fact that Chase Farm hospital has battled for many years against diseases such as MRSA. It is fighting bravely to remove them, but it would be much easier for the hospital to get to grips with such diseases if there was a sense of common and shared purpose among the staff. When the care quality commission considers hospital-borne infections and how standards could be improved, it cannot put to one side the fact that the morale in the hospital with which it is dealing is a contributory factor.
	One example of where I think the NHS is making mistakes relates to the subject of nurse morale. I was talking to a nurse who had finished her shift for the day and was getting ready to leave. She noticed that an elderly lady in one of the wards had not been fed that evening. Being a conscientious nurse and a human being, she decided to stay on and feed her. The nurse knew that if she left, those on the incoming shift would not take it upon themselves to feed that elderly woman. The window of opportunity would have been lost, so the nurse stayed back in her own time and made sure that that elderly person had supper and nutrition. That is important, because we know that a number of elderly people in care do not receive proper nutrition. Indeed, some are starved to near death.
	The nurse fed the elderly lady, got into her car and travelled 25 miles home. When she got home, she listened to her messages, including one from a hospital manager saying, "Please come back to the hospital, because you have not finished your paperwork." The nurse knows full well that such a message would not have been left if the elderly patient had gone unfed. If the nurse had done the paperwork, not fed the patient and gone home, nobody would have cared and that telephone call would not have been made. She has now left the NHS, which is a great loss to us all.
	The care quality commission must not allow people to get off the hook of accountability. Too often in these debates, a smokescreen is thrown up about who is in charge and about contract cleaners. My view is that the chief executives are in charge of their hospitals and they have to take ultimate responsibility for their being well run. I know that chief executives work under very difficult conditions. They have targets imposed on them and they have to meet benchmarks and work extremely hard to keep Whitehall happy. However, that is no excuse, and it must never be an excuse, for allowing people to lie in their own faeces, to lie in their own vomit, to go unfed and not to be cared for. That is an abrogation of responsibility on the part of those chief executives.
	Chief executives are paid considerable sums of money. Some earn well over £200,000, and with large sums of money come huge levels of responsibility. Too often, I feel that chief executives think that they are running a hospital well if they are sitting in their ivory tower surveying all those they command. I am not going to compare running a hospital with running a business; the two are very different. However, I will make the following comparison. Some successful people running enormous businesses make sure that they spend at least one day a week out in the business making sure that they know what the customer experience is like and that their customers are getting what they want. We need some more of that in the NHS. We should have strong management teams in the NHS that allow chief executives to get out of their ivory tower and their offices and to spend time on the shop floor.

Sandra Gidley: That is possible under the existing regime. The new chief executive at Winchester hospital makes sure that he eats hospital food under an assumed patient name once a week. He does a lot of things to be on the wards to see what is going on and carries out cleanliness inspections. Some would say that he should not have to do that, but that approach seems to be delivering results and more could learn from that lesson.

Charles Walker: The hon. Lady has made an important point. Some say that that should not be the case; I say that it absolutely should be the case. We need to see chief executives on the wards.
	Before the hon. Lady helpfully intervened, I was about to say that I was amazed when we were shown pictures of Maidstone hospital and saw the filth and the squalor that were allowed to go unaddressed. Any serious senior manager worth their salt would have dealt with that. What we saw was disgraceful. As I have said, with responsibility comes leadership and we need leadership in the NHS.
	Ideally, I hope that the care quality commission will be a passing phenomenon. I hope that we have it for five or six years, but that there will then be chief executives of sufficient quality to mean that it is accepted that hospitals are of such a uniformly high standard that we do not need to burden them with more regulation and more inspection. Until that time is reached, I very much see the need for the commission.
	In my final couple of minutes, I wish to deal with the issue of obesity and the weighing and measuring of children at school. Obesity is a huge problem. Short of people just closing their mouths and not eating, it is very difficult to address. I do not mean that flippantly because, in particular, we need to address the problem of obesity in children. Obesity in childhood can have an impact on a person's health outcomes throughout their life and place additional costs on the NHS. Perhaps the Minister can explain matters further either here or in Committee, if I am lucky enough to serve on it—that is not a hint, because I am very busy at the moment.  [ Interruption. ] That was an own goal.
	We weigh and measure children at school, but to what end? Is it just another form-filling exercise, or is there a strategy to utilise the information and make sure that our young people and their families get the support that they need to live healthy lifestyles and lose weight? We cannot really remove exercise from the equation. Many teachers in my primary and secondary schools give up huge amounts of their personal free time to lead sports activities in the afternoon or evening. We need to encourage more teachers to do that, and if need be, we should make it worth their while financially.
	Mr. Deputy Speaker, you have indulged me on occasions this evening and I thank you very much for your patience.

Hywel Williams: I am pleased to make a contribution to this important debate. I accept that, to an extent, the Bill focuses on the health sector and health care. However, I am a former social worker, a former teacher of social workers, and a one-time member of the Central Council for Education and Training in Social Work in Wales. I echo the words of the hon. Member for Blackpool, North and Fleetwood (Mrs. Humble): it is important that social care is not lost in the emphasis on health. The voice of the user must not be lost, either. That is one of the fundamental principles of social work and social care, and certainly something to which I attached great importance when I was teaching.
	Much of the Bill applies to England, but there are some points that are particularly relevant to Wales. I want to emphasise that there might be some cross-border issues and I seek reassurance from the Minister that they have been taken fully into consideration. The Welsh Affairs Committee is mindful of the implications of cross-border issues for health care in Wales and will conduct an inquiry early in the new year.
	There are particular arrangements in Wales. I would like reassurance that, for example, any implications of changes to the inspectoral arrangements in England have been taken into consideration. In Wales, we have our own body for regulating social workers: Cyngor Gofal Cymru, or the Care Council for Wales. It is separate from the General Social Care Council and operates on its own. Both bodies were set up under the Care Standards Act 2000. The Care Council is, like the General Teaching Council, a devolved body. However, the Care Council operates in the same area as the corresponding body in England and I am not wholly convinced that the operation of one will not have some influence on the operation of the other.
	The care quality commission in England will combine health and social care and inspection. As I have said, I am concerned about whether there will be implications for the inspectoral arrangements in Wales, particularly on a cross-border basis and when staff move from one employer to another across the border.
	The Care Council for Wales has a productive interface with health in Wales. There are regular meetings and training matters are discussed. However, it is important to realise that the work of the Care Council for Wales is not just focused on health. Its work also involves education, housing and community development matters. It works to a social model, not a health model. The care quality commission in England will combine health and social care inspection. Will the Minister let me know, either later or by means of a letter, what, if any, implications the Bill has for the inspectoral arrangements in Wales and the Care Council for Wales? Have there been discussions with the National Assembly Government and, if so, what were the conclusions?
	I have a particular example. Should the Care Council wish to change, vary or develop its work, I take it that that could be achieved through regulation, under clause 114. I note that clause 115 states that the standard of proof that is to be applied may not be varied in Wales, as compared to England. Will the Minister confirm that the power through regulation will be sufficient and that there will be no need to transfer legislative competence over the Care Council for Wales to the National Assembly? Will there be a need for legislative competence orders? They are already coming through and can take some time. Has he had any discussions with the National Assembly for Wales on the matter? I might be worrying unnecessarily, but I would value an assurance from the Minister.
	Clause 116 is on the training of mental health professionals. The regulation-making power for that lies with the Care Council for Wales. It is a Welsh matter, but again I hope that the Minister or his officials have had the opportunity to discuss it with the National Assembly. I am going into some detail, but I not seeking a place on the Committee. The Bill is largely concerned with matters in England.
	My second group of concerns is about the Welsh language and the implications under the Welsh Language Act 1993. The provision of services by a public body is subject to the Welsh Language Board and operates under a Welsh language scheme that has been approved by the Welsh Language Board. I am thinking in particular of developing needs in relation to mental health. When people are assessed for compulsory admission, a language choice is available. To some extent, that will be a matter of regulation for the Care Council for Wales. However, the Mental Health Act Commission is being merged under the Bill. I want to be reassured that Welsh language issues have been taken into consideration.
	I think great changes are going to be carried out in relation to mental health legislation in Wales. I mentioned compulsory admission. There is going to be a legislative competence order, which we hope will transfer to the National Assembly the right to legislate in this area. That is being proposed by a Conservative Member of the Assembly. The point is that the care quality commission will take on the duties of the Mental Health Act Commission in Wales and I want to be reassured that it will have a Welsh language scheme from day one. There was a discussion some time ago when the Children's Commissioner for England was set up and had some duties as far as children in Wales were concerned. I had a long session with the relevant Minister to try to persuade her to set up a Welsh language scheme from day one. After 13 questions, she agreed to write to me, and eventually we got a Welsh language scheme. However, that scheme needs to be there from day one. After all, patients will have concerns from day one, particularly on the difficult matter of mental health.
	There is considerable expertise in Wales on language matters, particularly in relation to social care and mental health. Looking at schedule 9, it seems that the principles of the Welsh Language Act should underpin provisions such as paragraph 2(e), which refers to standards of conduct, and paragraph (9), which imposes conditions for regulation.
	I look to the Minister for reassurance that those particularly Welsh issues have been taken into account. Generally, I welcome the Bill, as other Members have.

Angela Browning: I apologise to the House for the fact that I was not present at the beginning of the debate, but I wrote to the Speaker last week to explain why I would be late. I meant no discourtesy to the House. I have a particular interest in the Bill and I wish to make a brief contribution on Second Reading.
	When merging the Mental Health Act Commission, the Commission for Social Care Inspection and the Healthcare Commission, I hope the Government will take on board the fact that there is such an overlap of service out there, and rightly so. The service that we should seek to provide, particularly for patients, should be seamless, but despite the Government's best efforts to merge health and social services, we all still come across a great deal of casework in which it is difficult to take matters forward because of the glass walls that seem to exist between areas of responsibility.
	The care quality commission that the Bill creates will be responsible for inspection and standards and will, we hope, facilitate crossover and ensure the seamless delivery of services. If the system is too compartmentalised, people's conditions and the difficulties that they are encountering will fall down the middle. I am sure the Minister will take that on board. We need to address the matter, not least because, in the context of inspection, there are some groups for which we will have to provide to make sure that the services that are delivered to them and the way in which those services are delivered do not disadvantage them. I shall give two quick examples.
	Across health and social services, we talk about adolescents, but whether we are talking about physical health, mental health or social services, all too often adolescents find themselves in inappropriate situations because sometimes it is difficult to judge whether children's services or adult services are best for them, for obvious reasons. They are young people going through the transition from childhood to adulthood, and tailoring the services and the quality of the service or care that they are given can be a difficult call for professionals. I hope the Minister will accept that whatever system is put in place when the care quality commission comes into being, it will need to address the particular circumstances of adolescents and ensure that the service meets their needs and that the inspection reflects the issues.
	Another aspect of the care quality commission that I want to raise with the Minister is the fact that the Government want to take away from the people responsible for inspections the right to look into second stage complaints from individual patients or, occasionally, patients' relatives. Although the Bill does not focus primarily on that, will it give substantial reassurance about the system that is likely to replace that? I know that the Government are going out to consultation, but many of us feel unhappy that something is being taken away before we have a clear idea of what will replace it. I hope the Minister will address that.
	Another issue that I shall touch on is the extension of direct payments. I declare an interest, as I am responsible for assisting a dependent adult relative who is the recipient of direct payments. I take co-responsibility with him and help him to complete his forms. I have been a great advocate of direct payments so I welcome the extension proposed in the Bill, but I flag up a concern. Apart from my constituency casework, wearing other hats I get involved in other casework around the country. Some authorities administer direct payments well, and others do not. Some seem to think that that is a cheap option.
	Some authorities could serve as models of best practice from which others could learn. Will the Minister consider looking at those that perform particular functions well in order to encourage the others to go and learn? For example, I mentioned that I helped with paperwork. In the authority that I deal with—I should tell the Minister that it is not an authority in Devon—the process has been made so simple that it is a joy to undertake. In some authorities, however, where people have been asked to make arrangements to buy in their own services, existing services have been removed and people have been left floundering, trying to find out where they can buy in.
	The extension that the Government propose deals particularly with extending direct payments to those who lack capacity. They will be least able to shop around without a little guidance, not least to ensure that they are buying from a bona fide provider. We all know the difficulties for those who lack capacity, especially if they are not assisted by an immediate carer. Not all of them have an immediate carer to guide and assist them in buying in their package. Direct payments are a great idea, but one or two details need tidying up in order to improve the service, especially if it is to be extended to that group.
	I was not in the Chamber earlier, so I shall not dwell on my next point. I flag up to the Minister a concern about clause 145, which deals with electronic records. I am sure that my hon. Friend the Member for South Cambridgeshire (Mr. Lansley) on the Front Bench and others raised the matter. In the light of recent events, there is clearly a need to get the provisions spot-on. I hope the Minister will go back to the drawing board to make doubly sure that this part of the Bill will be a new dawn in the collation and management of electronic records.
	The House has been generous in allowing me to speak, even though I was not present earlier. I have one further point. Across health and social services, there is one group of people who worry us all enormously. In his speech my hon. Friend the Member for Broxbourne (Mr. Walker) touched on the care of the elderly. There are issues such as end-of-life care, of which we have all had experience in our personal lives or in the casework that we have dealt with.
	The Government should focus on the inspection and delivery of end-of-life care. Very elderly people, often unsupported by immediate family or friends, struggle when they go into hospital or into residential or nursing care, at a time of their life when the service should be a Rolls-Royce service. If we do not give priority to people at the very end of their life, that is an indictment of us as a society and as a country. I hope the Minister will bear that in mind when he brings the Bill to the Committee.

Stephen O'Brien: It is a privilege to follow my hon. Friend the Member for Tiverton and Honiton (Angela Browning), with her deep commitment and expertise in health and social care. I pay tribute to all that she has done to help all of us in the House, without fear or favour, to chart our way through difficult and sensitive matters.
	We have had wide-ranging debate this evening, as befits such a wide-ranging Bill. My hon. Friend the Member for South Cambridgeshire (Mr. Lansley) called it a portmanteau Bill. My right hon. Friend the Member for Witney (Mr. Cameron) has made it clear that when the Government are doing the right thing for the country, we will work with them. Indeed, we will encourage them to go further, where that is the right thing to do.
	In some crucial areas the Bill does not go far enough. Although we support it in principle, and do not intend to divide the House on it tonight, we look forward to developing the Bill to benefit patients and front-line health care professionals, not least by importing aspects of our own White Paper, which we have already published—although I shall, of course, try to stay in order. I am aware that Ministers have been provided with copies, which I hope they have read from cover to cover. We have published the NHS autonomy and accountability Bill, which, unusually, we will introduce during this Session. We want to include, at last, our proposals for a genuine patients forum that has teeth and independence—HealthWatch.
	We looked in vain in the Bill for the vision and the overarching transformation, the prospect of which the Prime Minister, on taking office recently, highlighted. However, so far we have been disappointed, as was rightly noted by my hon. Friend the Member for Preseli Pembrokeshire (Mr. Crabb) in an analytical and powerful speech; I hope that we shall have his cogent participation in Committee. My hon. Friend was right to observe that the Bill is no testament to the Prime Minister's aspiration for a vision—if, that is, he is still looking for one.
	It is also worth noting that of 161 clauses, 38 depend on future regulations, the majority of which will be subject to the negative procedure. It is a great shame that the Government are too nervous, or lack the confidence, to bring forward a substantive debate on the Floor of the House on many of the measures. We shall seek to debate them in Committee, and I hope that the Minister will make available to the Committee in good time the draft regulations and examples, so that we can debate the best interests of patients and the public, rather than the leviathan power of the Secretary of State.
	It would have been helpful of the Minister to have started by demonstrating his good intentions and informing the official Opposition that he was publishing today—the day that we are debating the Bill—the draft section 60 order. He did not mention that to me at the briefing meeting that we had a few days ago. I hope that he will be able to make up for that lack of foresight.
	We might also note that 10 of the major provisions in the Bill do not carry an impact assessment, including the creation of the office of the health professions adjudicator, the health in pregnancy grant and the devolution of the pharmacy global sum to primary care trusts. One has to wonder whether the Government think so little of their own policies that the impact is not worth assessing. More worrying is the question of whether the work has been done, and is available for scrutiny by the House.
	The hon. Member for Caernarfon (Hywel Williams) discussed cross-border concerns. As an MP with an English constituency that borders Wales, I am all too well aware of the complexities and difficulties, and the fact that citizens on both sides of the border often seriously feel that there is a lack of fairness in respect of the health or social care provision that they receive.

Rob Marris: The hon. Gentleman has been following the Bill a little more closely than I. Can he tell us whether there is a legal aid impact assessment, which I believe all Bills should have? There may be a legal aid aspect; people may go to the new body for assistance with judicial review, for example.

Kevin Barron: Declare your interest.

Stephen O'Brien: The Chairman of the Health Committee has just said that I should declare an interest: recorded in the Register of Members' Interests is the fact that I am a non-practising solicitor.

Kevin Barron: I was talking to my hon. Friend the Member for Wolverhampton, South-West (Rob Marris).

Stephen O'Brien: I do not know what the current status of the hon. Member for Wolverhampton, South-West (Rob Marris) is in the law.
	I hope to develop this point a little later, but it is interesting that the proposals are not clear about whether somebody subject to the adjudication process has rights of representation. They might need to avail themselves of legal aid, irrespective of the hon. Gentleman's point. I have not seen whether there is a legal aid impact assessment, but the fact that I did not see one on my first reading did not surprise me.
	I should like to highlight the point made by my hon. Friend the Member for Tiverton and Honiton on the direct payment extensions. There is unquestionably a lot to be done to iron them out so that they are smooth-running. However, there is no question but that as a matter of principle they are the right way to go when they fit the circumstances of both the cared-for person and the person who assists. Most importantly—and this point cross-refers to other elements of the Bill—my hon. Friend was absolutely right to highlight the fact that the Government have not put forward proposals for benchmarking and the transfer of best practice. That proposal was extremely constructive. I hope that we may have the benefit of hearing more about it if my hon. Friend is lucky enough to be considered to serve on the Committee.
	In his authoritative and all-encompassing speech, my hon. Friend the Member for South Cambridgeshire made clear our position on the care quality commission.  [Interruption.] I did have to say that—because my hon. Friend's speech was considerably more impressive than the Secretary of State's. The Government are moving in the right direction, but they have not gone far enough, as I have said. In the simplest analysis, the CQC will not be independent of Ministers, despite the Secretary of State's claim. As the hon. Member for Wyre Forest (Dr. Taylor) observed, the legislation fails to set out the commission's core duties and responsibilities beyond the most anodyne of statements coupled with a crude fining system. At this point, we should note the genuine demand for the seamlessness mentioned by my hon. Friend the Member for Tiverton and Honiton.
	I hope that the Minister will take the opportunity to answer the question put by my hon. Friend the Member for South Cambridgeshire. It was about the Appointments Commission, which is currently responsible for the appointment of the chairs of the Healthcare Commission and the Commission for Social Care Inspection. In his answer, the Secretary of State said that that would not be the case for the CQC because the job was so important that it could not be left to the Appointments Commission. That answer was most surprising, and I dare say he may reconsider it.
	Until our proposals for an NHS autonomous of ministerial meddling, with separate and independent quality and independent regulators to support it, are delivered, the Bill will do little more than bring about an amalgam of existing bodies, with their existing constraints. Furthermore, without a strong national patient voice, that regulator will lack the necessary checks and balances to operate most effectively . We hope that the Bill provides the opportunity for us to seek to strengthen LINks to provide that.
	The hon. Member for Blackpool, North and Fleetwood (Mrs. Humble) rightly advocated listening to the voice of the user. The hon. Member for North-West Leicestershire (David Taylor) advocated the use of citizens councils; that idea might go a little further than most of us would wish. However, I hope that his point is at least explored in Committee so that we can discuss its merits and demerits.
	Another question was raised that remains unanswered; perhaps the Minister will take the opportunity to answer it when he winds up. In the development of the new institutions, the complaints system is effectively being taken back fully in-house. There is a big question mark about the absence of true independence; a question was raised about whether the health service ombudsman has the capacity to deal with the anticipated higher incidence of complaints that will find their way to his desk. That point, too, was emphasised by the hon. Member for Wyre Forest. I hope that the Minister will clarify the issue.
	Many organisations have expressed concern that the experience built up by the Mental Health Act Commission, the Commission for Social Care Inspection and the Healthcare Commission will be lost. We shall seek assurances from the Government that the establishment of the CQC will not mark yet another year zero, particularly given the continual upheaval that the Government have brought to social care regulation. My hon. Friend the Member for Broxbourne (Mr. Walker) made a serious and passionate speech in which he made it clear that we also need to make sure that the Government give assurances that the social care and mental health responsibilities of the CQC will not be squeezed out by its Healthcare Commission-type functions. For example, have the Government made allowances for the impact of community treatment orders on the work of the MHAC? What work will the CQC do in prison health care? That point has not been raised. We should consider the point, raised by my hon. Friend the Member for Worthing, West (Peter Bottomley) in his excellent and comprehensive speech, about the appropriate use and deployment of magistrates under the Bill.
	My hon. Friends have deplored the Government's failure to combat health care-associated infections effectively. That the Government are embarrassed by that is clear from the fact that the relevant provisions are buried deep in the Bill. However, we guarantee—as will others from across the House, I am sure—to make sure that Ministers are engaged in a frank and open debate as we go through the Bill's parliamentary stages.
	As for professional regulation, we want proportional regulation that protects patients and the public, as well as innocent doctors. My hon. Friend the Member for South Cambridgeshire flagged up our debates on the role of the office of the health professions adjudicator. If Ministers believe in self-regulation, as we do, why is the OHPA required? We must leave that question hanging for them to answer, today or in Committee. It was interesting to hear from the right hon. Member for Rother Valley (Mr. Barron) about his experience of serving on the General Medical Council, which raised the question of why it is necessary to have another body in addition to developing the role of the GMC. His speech was restricted to that subject, but I hope that as Chairman of the Health Committee he will devote some time to, and take equally seriously, the social care aspects of the Bill.

Rob Marris: Does the hon. Gentleman agree that we need state regulation of psychotherapists?

Stephen O'Brien: I might have to lie on the couch to think about that. I do not see it as being within the scope of the Bill—far from it. It is the subject of numerous submissions and considerable argument, and it would be much better for us to discuss it in a rather more serious and considered way than in this very short exchange.
	My hon. Friend the Member for South Cambridgeshire has helpfully found an assurance for the hon. Member for Wolverhampton, South-West on his earlier intervention about the legal aid test. I draw his attention to annexe C1 of the impact assessments document, which says:
	"As stated in the evidence base, it is not expected that the number of orders made to a justice of the peace, (currently approximately 10 orders per year) or the numbers of prosecutions (currently none brought) will significantly increase. Therefore there is likely to be little impact on the work of the courts. Consistent with this, there is likely to be little impact on legal aid."
	It does not address the question of the impact on the health service ombudsman, who would be the point of appeal of last resort.
	There is another matter that we need to be clear about as regards professional regulation. We know for sure that strong submissions will be made to the Committee about the proposals on the standard of proof. I reconfirm that we support the change from a criminal to a civil burden of proof in principle, but the Government have not yet provided clarity on the flexibly applied nature of the imposition of the new standard. We will not only seek to draw out the likely impact of the changes but seek assurances on the application of the sliding scale. I submit that evidential proof should be to the civil standard but, given that the ultimate sanction is to deny somebody their living, the procedural rules should be as for a criminal case, where someone knows the evidence against them well in advance and has the opportunity to test it extensively. I also hope that the Government will entrench in the Bill a more positive approach to professional regulation, bringing greater opportunities for benchmarking and professional development.
	Hon. Members raised several points about public health and health in pregnancy. My hon. Friend the Member for Guildford (Anne Milton) will take those matters through Committee, so I shall leave them for her to develop extensively. Interestingly, the miscellaneous provisions are quite substantive. In its breadth, the Bill gives us an opportunity to debate several key issues regarding the provision of health and social care. Sadly, the solutions proposed by the Government do not appear to be sufficient or sufficiently focused. That is true of this Bill as of so many others. That gives us the chance to try to improve it immeasurably, and I hope that we can do so for the sake of the future health care of our constituents, patients and the public. It is our social responsibility to give them the social care that they deserve.

Ben Bradshaw: This has been a wide-ranging, well informed and constructive debate. I am pleased that the main provisions of the Bill appear to enjoy broad support across the House, and I look forward to debating them with hon. Members in more detail in Committee. I will try to respond to as many of the points raised during the debate as possible, but if I omit some I will endeavour to write to hon. Members with the answers to their questions.
	My right hon. Friend the Member for Rother Valley (Mr. Barron), who is Chairman of the Health Committee, made an interesting speech based not only on his chairmanship of the Committee but on his long-standing membership of the General Medical Council. I listened with great care to what he said and hope to use a lot of it when dealing with the detail in Committee. I am pleased that he welcomed the broad thrust of the Bill. He also welcomed the move to an integrated regulator. I entirely agree that that transition needs to be handled with care, as other hon. Members said. I also noted his welcome for the reform of professional regulation based on his GMC experience. I agreed with everything that he said about that. He rightly pointed to the important role of responsible officers. They were not explicitly mentioned in Dame Janet Smith's inquiry, but, in response to a point made by the Opposition spokesman, I can say she dealt with what they will deliver in her recommendations. As my right hon. Friend alluded to, having responsible officers should mean that we can avoid the situation where many cases that could be managed and resolved locally have to go to the top. I hope that we all welcome that.
	My hon. Friend the Member for Blackpool, North and Fleetwood (Mrs. Humble), who is the chair of the all-party group on this matter, spoke with a great deal of expertise about social care. She welcomed much that was in the Bill, such as health in maternity grants and the direct payments, although she wanted those to be handled with care, as did the hon. Member for Tiverton and Honiton (Angela Browning). I absolutely agree with her about that. She raised a concern that several other hon. Members raised, and the Commission for Social Care Inspection has raised it with me at several meetings. I hope that I have reassured the commission that the integration of the three regulators will not mean that it or the mental health body are overwhelmed by the health body. Both now and in Committee I hope to give my hon. Friend the reassurances she seeks. She is absolutely right about the need to handle carefully the integration of the different cultures involved. She was right when she said that the social care sector brings something new to the party—something from which the health sector can learn. I will take on board her remarks when the Bill passes into Committee.
	My hon. Friend used the term "light touch", and it was used by one or two other hon. Members as well. I prefer to use the term "risk-based and proportionate". Having read the Bill, she may have noted clause 2. I hope that it will reassure her on the issue of vulnerable people because it makes it clear that the new regulator must pay heed to the safeguarding of vulnerable adults and children in the fulfilment of its duties. She also asked about self-funders. I have discussed that matter with the Under-Secretary of State for Health, my hon. Friend the Member for Bury, South (Mr. Lewis), and we recognise the issue. We are considering how we can use the regulatory powers in the Bill to address the matter as it passes through the House.
	The hon. Member for Worthing, West (Peter Bottomley) made a very positive contribution on public health, and on how the health in pregnancy grant needed to be seen in the context of public health more generally, including pre-conception health. I entirely agree with that. He pretty much supported the changes that will be made to regulation. He raised a point that was made by Liberty. I am afraid that I have not had sight of that, but I will find out about it, and write to the hon. Gentleman and Opposition Front Benchers about the role of magistrates and detention. I assure him that the consultation will be genuine.
	My hon. Friend the Member for North-West Leicestershire (David Taylor) spoke largely about the role of citizens councils. I hope that the new regulatory regime in the Bill will provide him with the reassurance he seeks, but I shall reflect on the suggestion that he made about the role of citizens councils, particularly under the auspices of the Council for Healthcare Regulatory Excellence. I am sure that he realises that the lay membership of the CHRE is being reduced because the overall membership is being reduced. The regulatory representatives are leaving because we do not want it to be a body that is made up of such representatives; we want it to fulfil a slightly different function. It will be smaller, and I shall certainly look at his idea. The CHRE has a duty under the proposals to consult the public and organisations representing patients' interests, so there may be scope for considering it.
	The hon. Member for Preseli Pembrokeshire (Mr. Crabb) was critical, slightly unfairly, of the health in pregnancy grant. Other grants are already available that address some of the issues he referred to in relation to early pregnancy, and they are means-tested. There is evidence to suggest that mothers, particularly the less well-off, spend money that they are given in the interests of their children, both born and unborn. There is evidence from countries that grant similar help—Finland, Belgium and France—that it addresses the serious problem of low-weight babies, which, I am afraid to say, we still have in this country. We do not have a very good record on that. His point about termination was another argument for making the grant at 25 weeks, if I may put it like that.
	My hon. Friend the Member for Dartford (Dr. Stoate) raised wider issues of obesity, most of which are outside the scope of the Bill, but it was still a good speech. I agreed with almost everything he said. As a former chairman of the all-party group on cycling, he would expect no less. I hope that some of the issues that he raised will be addressed more comprehensively when we come to publish our forthcoming obesity strategy.
	On the issue of pharmacy and the global sum, which was also mentioned by the hon. Member for Romsey (Sandra Gidley), I hope that I can reassure my hon. Friend that PCTs will not simply be able to siphon off the funding for pharmaceutical services or to vary nationally negotiated fees and allowances for essential and advanced services. They will continue to be set nationally. I am intensively engaged with the pharmaceutical representatives, as is my right hon. Friend the Minister of State. When we come to publish the White Paper there will be huge possibilities for pharmacy and for pharmacists, particularly in primary care, to deliver the vision that is shared by both sides of the House.
	The hon. Member for Wyre Forest (Dr. Taylor) welcomed the move to an independent regulator. He said that we were short on listing its duties but I refer him to clause 2, which lists those duties fairly comprehensively. A balance must be struck when setting up an independent body as to how much one can dictate its duties and how it is expected to fulfil them. We have struck a good balance with the duties that we expect the regulator to fulfil and how it should go about them. We do not want to put it in too much of a straitjacket, because that would compromise its independence. We are trying to strike the right balance.
	The hon. Gentleman managed to spot an important element of the Bill that was not spotted by anyone else. That was the role that the commission will play in PCTs and commissioning, which is vital if the new independent body is to have the role that we think that it needs. The current body does not have that role. The hon. Gentleman was right to highlight the importance of that.
	We dealt with LINks during the hon. Gentleman's speech. LINks do not come within the scope of the Bill, as they are already on the statute book. We have told the Healthcare Commission that we expect the new regulatory body to work closely with LINks on inspections and on how it goes about its work. The body should consult LINks and work closely with them. The commission will have a duty to have a panel made up of patients' representatives to advise it. I have not had sight of the TUPE issues, but I shall find out about them and write back to him.
	The hon. Gentleman also talked about complaints, as did a number of other hon. Members. I think that I share their concerns. There should be recognition from all parties that the way in which a lot of health organisations on the ground handle complaints is not great. We want to try to reduce the number of complaints that are not handled well locally. The ombudsman—we should say ombudswoman in this instance—will deal with second stage complaints. We have discussed capacity with her and she is satisfied that she will not be overburdened, but we will have to deal with those issues carefully.
	We did not want to burden or slow down the work of the important new regulatory body, whose main priority will be safety and quality for patients, by making it deal with complaints. That should force us all—and the health service in general—to do a better job of dealing with complaints. Of course, the new care quality commission will have a role in deciding whether organisations deal with complaints properly. Nothing will stop a patient from making a complaint as in the example of Cornwall. That led to an important and far-reaching inquiry.
	The hon. Member for Broxbourne (Mr. Walker) rightly recognised the important role that the care quality commission will play in helping to continue to drive down health care-acquired infections. The hon. Member for Caernarfon (Hywel Williams) asked about a number of Welsh issues. I am assured by my officials that they have worked closely with Welsh colleagues and that we have agreement with Welsh Ministers on those issues on which we will need to agree. I am assured that we have been taking the Welsh language issues seriously, too. I shall write to the hon. Gentleman with clarification on the other detailed points about the Welsh perspective that he mentioned.
	I do not begrudge the fact that the hon. Member for Tiverton and Honiton was late. She made an important contribution as always, based on her long personal experience, about the need for seamless service and a seamless system of inspection. It is right that we should focus on that when we discuss the issues in more detail in Committee. She also mentioned complaints, which I have dealt with. She supported direct payments, which I was pleased to hear, but she thought that best practice needed to be learned from. I agree entirely. The new regulator may want to consider how practice can be improved across the piece to bring the performance of those local authorities that are not as good up to the level of the rest.
	The hon. Member for Romsey, who speaks from the Front Bench for the Liberal Democrats, broadly welcomed the Bill but did not believe that there should be a one-size-fits-all approach. I agree. The new commission needs to take a proportionate, risk-based approach that takes on the strengths of the three existing organisations. It needs to be sensitive to their strengths and differences. I hope that I can reassure her through my comments on Second Reading and in Committee that fears of health domination are not justified. When the Bill was published, we held intensive discussions with all three organisations and they broadly welcomed it.
	I was disappointed when the hon. Lady described the health in pregnancy grant as a "bit of a gimmick." It is not. Some people may think that £190 is not much, but it means a great deal to many women in my constituency. It will be an enormous help to them in those last few months of pregnancy when they have to make difficult choices about spending priorities. I am sure that the hon. Lady did not mean to suggest the contrary.
	I will write to the hon. Lady about body mass index. I understand that we are considering the matter. One difficulty is that many people do not understand what body mass index means whereas they understand height and weight. We are also considering the follow-up for parents to give the provision more substance.
	Someone mentioned the Human Rights Act 1998 and independent sector homes. We hope to be in a position to tackle that in the forthcoming Green Paper on the British Bill of Rights and duties, which would allow us to deal with the matter in the wider context of the public authority definition. Including that definition in the Bill causes a problem because it is so vast. However, we will strengthen the regulatory powers in the measure to ensure that the care quality commission can enforce the requirements in line with the relevant provisions of the Human Rights Act.
	The hon. Member for South Cambridgeshire (Mr. Lansley) asked about the independence of the appointments system for members of the care quality commission. I assure him that the Bill proposes no change. The Secretary of State already has such a power but he devolves it to the Appointments Commission. We have made it clear that that will continue.
	We have heard a little from the Conservatives today about their alternative Bill. We welcome some of their suggestions—indeed, we are already implementing them. We especially welcome their professed conversion at last to a taxation-funded NHS free at the point of need. However, their alternative is also deeply flawed. It professes to support devolution to the local level, yet Conservatives want to stop all local reorganisations of services, whatever their clinical merits. They call it a moratorium on reconfigurations; I call it a moratorium on saving lives. They talk about local and national accountability, but want to hand the big decisions to an unelected quango of bureaucrats.
	Since 1997, we have put record investment into the NHS, making genuine improvements in care, slashing waiting times, saving lives and boosting quality of life. Reform has come with that investment, driving up standards, giving patients genuine choice and improving efficiency. There have been continued real-terms increases in investment in health. The Bill will build on those achievements, leading to fewer quangos, less bureaucracy, better safety and quality, more transparency and genuine accountability—a health service fit for the aspirations of the British people. I commend the measure to the House.
	 Question put and agreed to.
	 Bill accordingly read a Second time.

HEALTH AND SOCIAL CARE BILL (PROGRAMME)

Motion made, and Question put forthwith, pursuant to Standing Order No. 83A  ( Programme motions),
	That the following provisions shall apply to the Health and Social Care Bill:
	 Committal
	1. The Bill shall be committed to a Public Bill Committee.
	 Proceedings in Public Bill Committee
	2. Proceedings in the Public Bill Committee shall (so far as not previously concluded) be brought to a conclusion on Thursday 24th January 2008.
	3. The Public Bill Committee shall have leave to sit twice on the first day on which it meets.
	 Consideration and Third Reading
	4. Proceedings on consideration shall (so far as not previously concluded) be brought to a conclusion one hour before the moment of interruption on the day on which those proceedings are commenced.
	5. Proceedings on Third Reading shall (so far as not previously concluded) be brought to a conclusion at the moment of interruption on that day.
	6. Standing Order No. 83B (Programming committees) shall not apply to proceedings on consideration and Third Reading.
	 Other proceedings
	7. Any other proceedings on the Bill (including any proceedings on consideration of Lords Amendments or on any further messages from the Lords) may be programmed.  —[Liz Blackman.]
	 Question agreed to.

HEALTH AND SOCIAL CARE BILL  [MONEY]

Queen's recommendation having been signified——
	 Motion made, and Question put forthwith, pursuant to Standing Order No. 52(1)(a) (Money resolutions and ways and means resolutions in connection with bills),
	That, for the purposes of any Act resulting from the Health and Social Care Bill, it is expedient to authorise—
	(1) the payment out of money provided by Parliament of—
	(a) any sums payable by virtue of the Act as health in pregnancy grant under the Social Security Contributions and Benefits Act 1992 or the Social Security Contributions and Benefits (Northern Ireland) Act 1992,
	(b) any other expenditure incurred under or by virtue of the Act by a Minister of the Crown or by a government department, and
	(c) any increase attributable to the Act in the sums payable under any other Act out of money so provided, and
	(2) payments into the Consolidated Fund. —[Liz Blackman.]
	 Question agreed to.

COMMITTEES

Mr. Deputy Speaker: If the House is content, I shall put motions 4 to 8 together.
	 Ordered,

Administration

That Helen Jones be discharged from the Administration Committee and Mr John Heppell be added.

Children, Schools and Families

That Joan Ryan be discharged from the Children, Schools and Families Committee and Mrs Sharon Hodgson be added. .

Health

That Mr Ronnie Campbell be discharged from the Health Committee and Stephen Hesford be added.

Northern Ireland Affairs

That John Battle be discharged from the Northern Ireland Affairs Committee and Stephen Pound be added.

Regulatory Reform

That Mr Andy Slaughter be discharged from the Regulatory Reform Committee and Judy Mallaber be added. ——[Rosemary McKenna, on behalf of the Committee of Selection.]

UNION FLAG (GOVERNMENT BUILDINGS)

Motion made, and Question proposed, That this House do now adjourn. —[Liz Blackman.]

Ian Lucas: I am pleased to have secured this debate on the important issue of the flying of the Union flag on Government buildings. The Government are currently consulting on the flying of the Union flag and, more broadly, the consideration of the United Kingdom's national culture and citizenship are very much to the fore. The Government's consultation document says:
	"The Union Flag is one of the most recognisable symbols of the UK."
	It is recognised worldwide and its history is an expression of the history of the United Kingdom, of Great Britain and of Northern Ireland.
	The Union flag was first introduced in 1606, following the accession of James VI of Scotland to the English throne. James I of England, as he became, had a strong vision of a unified kingdom of Great Britain. The combination of the cross of St. George and the saltire of St. Andrew was the physical expression of that vision. The flag represented the novel constitutional arrangements of Great Britain. That principle was carried forward in 1801 when a new version of the Union flag was introduced incorporating the cross of St. Patrick, following the Union with Ireland Act 1800. The Union flag used today has therefore changed in the past to reflect the developing constitutional relationships within the United Kingdom.
	As a Member of Parliament from Wales, albeit one born in England, I am conscious of the integral role of Wales in the United Kingdom. The Act of Union of 1536 was not a merger; rather, it was a constitutional takeover of Wales by England and can be distinguished from the Act of Union with Scotland of 1707, which was approved by the Parliaments of England and Scotland. As a consequence, Wales's identity was suppressed within the Union for far too many years. It was only in the 20th century that Wales's identity began to be recognised. The creation of the Welsh Office was ultimately the precursor of devolution and was a formal constitutional recognition of Wales's distinctiveness.
	Following the Government of Wales Act 1998, further new constitutional arrangements exist for Wales. Wales's role as one of the four constituent nations in the United Kingdom is recognised formally by our constitution, which now has a Parliament in Scotland and Assemblies in Northern Ireland and in Wales. The Union flag, on the other hand, represents only three nations in the United Kingdom. Just as the Union flag has changed in the past, to reflect a new constitutional settlement when Ireland came into the United Kingdom at the start of the 19th century, I believe that the Union flag should now change to reflect the four nations of the United Kingdom: England, Scotland, Northern Ireland and Wales.
	How could that change be achieved? The three crosses making up today's Union flag are the crosses of the patron saints of the three countries represented on the flag. We could add the cross of St. David, but for me yellow and black would not create an ideal design. The recognised symbol of Wales is the Welsh dragon. I would like to see the incorporation of the Welsh dragon on to the Union flag, so that it would represent the four constituent nations of the United Kingdom. This is the Union flag that I would like to see— [ Interruption. ]

Mr. Deputy Speaker: Order. I must tell the hon. Gentleman that visual aids are not encouraged in the Chamber. He must describe the flag verbally.

Ian Lucas: The flag that I would like to see would represent all four parts of the United Kingdom, with the cross of St. George, the saltires of St. Andrew and St. Patrick and the red dragon of Wales. I appreciate, however, that that would require widespread consultation. Matters of taste will come to the fore. I would like the Government to consider the case that I have made and consult throughout the United Kingdom on changing the Union flag, just as it has been changed before, to give Wales an equal place on the national flag of the United Kingdom.

Stewart Jackson: I thank the hon. Gentleman for his generosity in giving way. I am listening to his speech with interest. What is his estimate of the likely cost of such a consultation across the whole United Kingdom for the proposals that he is outlining?

Ian Lucas: I have no estimate of the cost, but this is an extremely important matter. It is right and proper that we should consider the views of the people of Wales and the fact that they are not represented on the national flag. I find it disappointing that I do not appear to be commanding the hon. Gentleman's support on this matter. Similar changes have been made before, and this change would be to the benefit not only of Wales but of the United Kingdom, because the true constitutional picture of the nation that we are would be reflected on our flag.

Andrew Robathan: As someone whose father was born in Wales, whose name is Welsh and whose grandfather was a headmaster in Wales—I should say that I do not speak Welsh, however—may I say that I am interested in the hon. Gentleman's approach? Will he tell me how many people, by number, in his constituency have raised this issue with him as a matter of great importance? I do not think that it could be very many.

Ian Lucas: Not many people have raised this issue with me as a matter of great importance, but it is important to the people of Wales because we want to show to the world an expression of Wales's role within the United Kingdom.

Stephen Crabb: rose—

Ian Lucas: I should like to continue for a moment, then I will give way.
	The United Kingdom has a flag that is recognised throughout the world. If that flag were to be changed, it would encourage debate across the world and bring to the fore the representation of Wales across the world. I would hope that the hon. Member for Preseli Pembrokeshire (Mr. Crabb) would welcome that.

Stephen Crabb: I have enjoyed the hon. Gentleman's history lesson so far, and I applaud the way in which he has spoken up in defence of the United Kingdom, and of the symbolism surrounding the United Kingdom. Does he not think, however, that many of the people who read this debate will find it strange that these arguments are coming from a man who is a member of a party that has governed this country for 10 years and engaged in a decade of constitutional vandalism that has left us with a divisive and unstable devolution settlement that is ultimately going to pull this country apart?

Ian Lucas: I should like to commend to the hon. Gentleman an excellent book called "The Isles" by Norman Davies. It is a constitutional history not only of England but of the isles of Great Britain and Ireland. It shows that we have always had changing and developing constitutional relationships within the United Kingdom. I am surprised that the hon. Gentleman is not aware of that fact. We did not exist in a constitutional state of grace before 1997, as the Conservatives seem to think.
	The prime mover for devolution in the United Kingdom was Margaret Thatcher. Her ignorance of and disrespect for the people of Wales and Scotland, as well as many people in England, meant that devolution was inevitable. I am asking today for the existing constitutional relationships in the United Kingdom to be represented on the flag on our Government buildings.

Albert Owen: My hon. Friend is making an interesting and radical proposal. As someone who supports both devolution and the Union with the United Kingdom, I do not believe that there is any contradiction between being pro-Welsh and pro-British. That is the crux of his proposal to reflect the diverse nations and indeed regions of the United Kingdom on our flag. I am interested to find out what he would call the new flag. Would he call it the Union jack, or would he propose that we rename it the British flag?

Ian Lucas: I like "the Union flag", which is the flag's correct name, although it is commonly known as the Union jack. I would like the name "the Union flag" to be retained. It is the true flag of the United Kingdom, and I would simply like it to reflect the four countries of the United Kingdom in a way that it does not do at the moment.
	I do not believe that this is a dry, constitutional matter. As someone who was born in England, I believe that the people of Wales have good grounds for dissatisfaction that their nation is not represented on the national flag. If we want the Union flag to fly in Wales, we should include Wales on it. As I have shown, it is not as if we are talking about a change that has not happened before. In today's media age, changing an iconic image such as the Union flag may appear to be more difficult to achieve than it was 200 years ago, but none the less I believe that change is right.
	Let the debate begin. Let the rest of the world know that the iconic symbol of the United Kingdom may change and that the reason is that we have a new constitutional settlement that affords Wales its true place in the Union. I believe that such a debate will increase the recognition of Wales not just across the United Kingdom, but across the world.

Andrew Rosindell: May I congratulate the hon. Member for Wrexham (Ian Lucas) on obtaining this debate? I was interested to hear that the debate had been called and I wanted to be here because I have always believed that the flag of this United Kingdom should fly on Government buildings. I am thus delighted that we are having this debate, but it seems that the hon. Member for Wrexham has a different agenda. I did not recall him saying in his speech—I am sure he will correct me if I am wrong—that he actually supports the view that we should fly the flag, as I believe, throughout the year on Government buildings. He seems to be proposing an agenda that amounts to ripping up the current flag of our country and redesigning it to incorporate the Welsh dragon.

Ian Lucas: I am sorry that the hon. Gentleman was not listening to the debate. "Ripping up" was not a description that could be attached to my speech. What I said was that the continuing and evolving constitutional relationship within the UK should be reflected in its flag. As he heard—at least, he would have heard if he had listened—the flag has changed before because the United Kingdom has changed before. I want change to happen again.

Andrew Rosindell: I am one who does not want to see the United Kingdom changed. I believe in the United Kingdom. As the hon. Gentleman said, Wales was in fact connected to England long before the Act of Union, which created the Union flag—today's Union flag—and to change it at this stage would be a great mistake that would not be supported by the vast majority of people throughout the United Kingdom.
	When the hon. Gentleman speaks about the Union flag, which is commonly known, as he rightly says, as the Union jack, he should realise that it does not just represent the people of the United Kingdom. It is used by nations, territories and dependencies all around the world. The Union flag is not simply the flag of the United Kingdom because it is represented in the flags of Australia, New Zealand, most of the British overseas territories such as the Falkland islands and many other places, as he will know. It is also depicted on the flags of the states of Australia and Canada and even of countries that no longer retain the British monarchy, such as Fiji. Even Fiji retains the Union flag. The Union flag now represents far, far more than simply the United Kingdom. To change that flag today would have implications for nations, territories, dependencies and countries far and wide.

Albert Owen: The hon. Gentleman is making an interesting point about the Union flag being part of other nations' flags where the Queen is Head of State. Actually, in Wales there is an anomaly in that the Queen is Head of State, but the Welsh or Wales as a nation do not have any representation on the flag, which is the crux of my hon. Friend's proposal tonight. If the hon. Gentleman does not think that the Union jack should be changed, does he accept that the problem should be rectified in some other way?

Andrew Rosindell: The hon. Gentleman is quite right. I understand that many people in Wales perhaps feel that they are not properly represented on the Union flag. However, what about the people of the Isle of Man? Are they represented on the Union flag? Is he also suggesting that we should include the symbol of the Isle of Man or any other British territory or Crown dependency? To keep changing what is now an established and recognised symbol would, I think, be grossly irresponsible and very unpopular. It would denigrate the flag, which I am sure he would not want.

John Spellar: Is the hon. Gentleman saying that Wales is a Crown dependency?

Andrew Rosindell: Of course I am not. I acknowledge that, as the hon. Members for Wrexham and for Anglesey (Albert Owen) have pointed out, the people of Wales are not represented on the Union flag, but I have also made it clear that Wales was connected with England for many centuries before the Act of Union. If Wales was to be included it should have been included at the time of the flag's creation, and I think that it would be entirely wrong to do it now.
	I do not, however, want my speech to be dominated by the agenda of the hon. Member for Wrexham. I want to talk about the title of the debate as it appears on the Order Paper, "Flying of the Union Flag on government buildings". That is what the Government are currently consulting on, and I have a copy of the consultation paper issued by the Department for Culture, Media and Sport, "Flying the Flag". I have submitted my own opinions on the subject.
	I passionately believe that the Union flag, or the Union jack as the vast majority of people describe it, is a symbol of unity—not only unity in our own country and the United Kingdom, but a unity that cuts across divisions such as religion, ethnic background and class. All those things are overtaken by the fact that the Union flag represents all British people. It is a flag under which my father and both my grandfathers fought in the first and second world wars. It is a flag that I think the vast majority of British people are proud to see flying from Buckingham palace, as it does every day of the year except when the Queen is there and the Royal Standard flies. It is a flag that, sadly, we see flying from the Palace of Westminster only when the House is sitting. I have said in many debates that we should change that tradition. I am a traditionalist, but sometimes we need to change our traditions, and I think that we should fly the Union flag throughout the year.
	Those who visit France, the United States or, particularly, Scandinavia will see that those countries' flags are flown all the time. Many people even have flagpoles in their front gardens. A public building in Denmark would never fail to fly the Danish flag—and can anyone imagine the French flag not being flown from Government buildings in Paris, or the United States flag not being flown from buildings in America? Yet there seems to be a problem in this country. We seem to be hung up about whether or not we should fly the Union flag.
	Before I became a Member of Parliament, I fought a campaign in my constituency for the flag of our country to be flown from the town hall throughout the year. I regret to say that it was bitterly opposed by the then Labour administration of the London borough of Havering.

John Spellar: I fully take on board the points that the hon. Gentleman is making. Will he join me in congratulating my borough, the Labour borough of Sandwell in the west midlands, on flying the Union flag over council properties, and does he share my slight concern at the fact that the neighbouring Conservative borough of Dudley has taken the advice of its officers and is flying it only on the 16—or however many there are—so-called official days?

Andrew Rosindell: The right hon. Gentleman and I tend to agree on a number of matters, and this is one of them. I think that the Union flag should fly from all civil buildings—town halls, council buildings—and from all Government Department buildings. I also believe that it should fly from every school building. I would like to see a flagpole at the front of each school, with a different pupil each morning given the honour of raising the flag. I would also like to see the flag in each school assembly room.
	There is nothing wrong with the Union flag; we should be extremely proud of it. Sadly, however, there are those who over the years have either denigrated the flag and tried to make out that it represents only people with supposedly right-wing views, or tried to hijack it for their narrow political ends. I am completely opposed to both. Without trying to turn this into a party political debate, I must say that I was saddened when the Labour council in Havering in 2000 voted against my plan to fly the Union flag. Many people said that to do so would ignite bad feeling between races. Nothing could be further from the truth. People from ethnic minorities wanted the flag to fly more than anybody, because they see that flag to be as much theirs as the rest of us do. It is wrong to allow the far right—the British National party, the National Front or other such parties—to hijack the national flag.
	I would like all public buildings to fly the flag. I welcome the fact that the Union flag now flies from a number of Government Department buildings, but we are merely scratching the surface. We need a policy such as that in Australia and New Zealand; I think that they have flag Acts that clearly set out when the flag should fly. It is sad that the Department for Culture, Media and Sport suggests that we fly the Union flag for only 14 or 15 particular days a year, such as the Queen's birthday and the anniversary of the coronation. It would be a jolly good thing to see the flag flying throughout the year—all 365 days. Not only that, but I strongly believe that we in England should fly the cross of St. George—as my town hall now does. Practically everybody in Scotland flies the Scottish Saltire and I am sure that in Wales they do the same with the Welsh flag. Not only should we fly the Union jack, we should also be proud to fly the flags of the individual countries that make up the United Kingdom.

Albert Owen: The hon. Gentleman said he would like the Union flag to fly in schools—I presume he means throughout the United Kingdom, although he did not specify that.

Andrew Rosindell: indicated assent.

Albert Owen: The hon. Gentleman also said that he would like the flag of St. George to fly alongside the Union jack. Does he not understand that in Wales there is some hostility to having the Welsh dragon and the Union jack, because people do not feel part of the Union jack as their flag is not reflected in it? That is the point my hon. Friend the Member for Wrexham (Ian Lucas) is making in this debate. My father served as a British serviceman and was very proud to do so; he was a proud Welshman serving what was then King and country. The fact is, however, that the Union flag is not representative. We are all patriots—we are Welsh patriots and British patriots—but we in Wales do not feel part of the Union flag because the dragon or the cross of St. David is not on it. That is the issue.

Andrew Rosindell: The hon. Gentleman makes some valid points, and I understand and accept what he is saying. Perhaps there should be some discussion of how to resolve those issues, but I do not believe that the answer is to change the Union flag. Without trying to make out that Wales is a Crown dependency or an overseas territory, the fact is that the Isle of Man and Jersey and Guernsey have been linked to the British— [Interruption.] They might not be part of the United Kingdom, but the Union jack is accepted as a flag for them as well. It is the British flag. It represents all British people. Their flags are proudly flown. If we were to go to the Isle of Man, we would see its flag flying proudly alongside the Union jack. There is no problem there. I have recently been lucky enough to visit Guernsey, which is a Crown dependency. Guernsey has been linked to the British Crown since way back in 1066. For that reason, there has never been a problem. The Union flag can fly in St. Peter Port alongside the flag of Guernsey.
	I understand completely that Members from Wales have a particular point of view, and we ought to talk about that. However, the title of the debate on the Order Paper is "Flying of the Union Flag on government buildings". Most of the comments from Labour Members have not been about that; they have been about how they would like the Welsh flag to be incorporated in the Union flag. I do not believe that that is the most pressing issue that people in Wales are arguing for; I accept the points that have been made, but I think there are probably more important issues.
	The most important thing is the Union—keeping the Union together, preserving the United Kingdom and not undermining it any more. That is why I am completely sympathetic to Members from Wales who have a problem with the current flag; nevertheless, I ask that we broaden this debate. A consultation is going on and I hope that all the Members in the Chamber this evening have taken the trouble to send a submission to the DCMS. I will give way if anyone would like to comment on that. Well, perhaps they have, perhaps they have not, but I have, because I think that this issue is very important.
	As I said before, how many children are taught in schools what the Union flag represents? How many schools fly the Union flag? In America, there is pride in the flag and an understanding of what it represents. It would be absolutely right if we claimed our flag for the vast majority of British people, who see it as a symbol of unity, not a divisive emblem. I refer not only to the United Kingdom but to people of other backgrounds who, some may argue, perhaps see themselves as being excluded from that flag. I do not believe that most people think like that, although there may be one or two who do.
	However, we have a duty, as Members of Parliament, to ensure that the flag of our country does not become associated with groups on the far right or any other particular cause or project—that it is seen as everybody's flag, the flag for all British people, whoever they are, whatever background they come from and of whatever supposed class they are. What better way could there be to demonstrate that than to see the flag flown every day throughout the year from every school, every town hall and every Government building, and by businesses, as well? Why not? Many businesses in my constituency have since decided to fly the flag following its being raised above Havering town hall.
	I hope that Labour Members will reflect on this. I have been in politics for a number of years now, and I have grown up in a period in which many Labour politicians—certainly from my area—have denigrated the flag, saying that its use implies that one is somehow right wing or of the far right. Nothing could be further from the truth. I do hope that there has been a change of attitude in the Labour party, as there has been across the country. The Union flag is now a modern symbol. It is used by young people on so many different things. They wear it on their clothes; they have belts with the Union flag on, for example. I am sure that many Members now have a Facebook page. Many youngsters have Facebook pages, as do I, and those who look at mine will see that it carries a Union flag. Those who are English can also have the flag of England, and those who are Welsh can have the Welsh flag. People are proud of their flags, and so should we be.

Ian Lucas: The hon. Gentleman, who is being very kind in allowing interventions, mentions Facebook. I should point out that there is a Facebook site dedicated to discussing the absence of Welsh representation on the Union flag; indeed, there is a separate website that raises the same issue. I am not the only person who has seen this difficulty. Does the hon. Gentleman agree that we have made some progress in this debate, and is he prepared to continue the discussion?

Andrew Rosindell: I have been discussing this issue for some 10 years now with people of all different parties. It has been a pleasure, because I have seen everyone shift toward the argument that I have always put forward—that we should be proud to fly the flag of our country. The issue raised this evening—the lack of representation of Wales in the Union flag—is quite valid and we should of course debate it. I do not think, however, that too many people will be convinced that we should change the design of our current flag, but there should at least be an acknowledgement that Wales is not represented. This issue can of course be looked into further, but I do not believe that we would gain anything from opening up a contest for redesigning the flag of our country. It would be divisive, and while it might receive some support in Wales, I fear that there would be a backlash in the rest of the United Kingdom. I have also made it clear that the hon. Gentleman is not taking into account the implication that it would have on territories, countries and states that also use the Union flag, as currently designed, in their flag. On that basis, redesigning the flag would be wrong and I would oppose that, although I would be happy to continue discussing the matter.
	Where do we go from here? We can do all kinds of things. I hope that when the Government review this policy and when the consultation is completed, they will follow the example of Her Majesty the Queen. In the week of the death of Diana, Princess of Wales, the Queen decided that the Union flag would fly from Buckingham palace, and since that day it has always done so—the only exception is when the Royal Standard flies. If the Queen is able to decide that the flag should be flown from Buckingham palace, surely the rest of the country should take that as an example.
	I hope that the result of this consultation will be that the Union flag will be flown from public buildings, including town halls and schools, and that the Government will consider issuing an official guide to the flag so that every young person in every school, and everyone else, will understand the history of the flag, the purpose of flying it and its importance. Other countries produce an official guide, why does the United Kingdom not do so?
	Other countries have a flag Act, so perhaps we should consider having the same. A great example of that is Australia and New Zealand, which regularly fly their flags—flags are flown all over the place—and do so with great pride. I understand that in both those countries any member of Parliament can obtain a flag and present it to a local group, organisation or individual. They can also obtain portraits of Her Majesty the Queen and present them to a local group if they so choose—in Australia, those are provided by the Australian Parliament. I have checked that myself. Perhaps such a system could be considered under the Government's review of flying the flag from public buildings.
	I have referred on a number of occasions to the Crown dependencies and overseas territories. It is a great shame that we do not give recognition to their flags in our country. I am told by the Flag Institute that countries such as North Korea, Syria, Iran and Burma can fly their flags anywhere in this country—they are legally recognised—but if one wants to fly the flag of Gibraltar, the Falkland Islands, Jersey or the Isle of Man, one must get advertising consent. A review of the rules must take place, because surely the flag of any territory or nation that retains the same Head of State as us—Her Majesty the Queen—should be given recognition.
	Perhaps the Minister will also answer the question about the flying of flags at trooping the colour. Hon. Members may recall that last year there was publicity about that, because the flags of republics, such as Mozambique, were flown at Horse Guards Parade for the Queen's birthday, yet flags of the overseas territories were not. In the week that we were celebrating the 25th anniversary of the Falklands conflict, no Falkland Islands flag was flown in Horse Guards Parade, yet Mozambique's flag, complete with what I believe to be a Kalashnikov, was flown next to the Union jack there.
	We must review our policy on flying the flags. I hope that the Minister will agree that precedence should be given, certainly on the Queen's birthday, to countries that retain Her Majesty as Head of State. Mozambique has never had the British monarchy, and it is wrong that flags of republics should be given prominence at an event such as trooping the colour when flags of territories and dependencies that have been linked to the Crown and the United Kingdom for hundreds of years are not displayed. I hope that the Minister will look into that and report back to the House on it at a later date, in advance of trooping the colour.
	In conclusion, I once again congratulate the hon. Member for Wrexham. This has been a worthwhile and useful debate. I hope that some of the points that I have made will be taken on board, as will the points that he made. There is no firmer believer in the United Kingdom than me, and that is why I have always campaigned and fought for the recognition of all parts of it. I hope that all the issues raised in this debate will be considered and I leave the Minister with one final thought.
	We may have different political ideas on the opposite sides of the House, but there is a feeling in the country today that the Union flag is no longer a symbol of division. People no longer think, "Oh, we'd better not fly it in case it upsets someone." We have moved on from that period, which was only 10 years ago. There has been a mood change and people now want to see the flag of this country flown. It is high time that we, as Members of Parliament, and the Government took the lead. If we do so, we will simply be doing what Her Majesty the Queen has done for the past 10 years. If we follow her example, we will take the right step and show that we are true to our flag, our country and—most importantly—the unity of all peoples of our United Kingdom.

Stewart Jackson: It is a pleasure to follow my hon. Friend the Member for Romford (Andrew Rosindell). I know that he has long been a passionate patriot and advocate of the monarchy and the flag.
	We have, over the years, seen a degree of eccentricity in Adjournment debates, and tonight is no exception. As my hon. Friend has said, we may have been brought here on false pretences, but I wish to raise a few key issues. I believe that the people of Wales are practical and pragmatic people, and they have not concentrated on the power of symbols in the way that their Celtic brethren north of Hadrian's wall have perhaps done over the years. The Welsh people support the 1997 devolution settlement and they are much more interested in transport, the health service, schools and social services than in symbols and flags.
	The hon. Member for Wrexham (Ian Lucas) was sincere and well-meaning in his remarks, but he missed the point. A consultation process would be expensive and I do not think that it would result in a settled view across the UK. The hon. Gentleman admitted honestly that his suggestion does not even command the support of his own constituents. Far from being unifying, it would be divisive—

Ian Lucas: I have learnt a great deal about the United Kingdom by learning about the history of the flag. The consideration of what the flag means, and what it could mean if it were changed, could increase the understanding of my constituents and others of what the UK is and what the Union flag represents.

Stewart Jackson: I listen with interest to those points, but let us consider the practical issues in relation to the representation of our constituents. The hon. Gentleman's constituents have a National Assembly to represent their views on a range of devolved issues. In addition, they have the House of Commons and local authorities. They have parliamentary constituencies that are significantly smaller than those in England, so they are well represented in our constitutional system. There is no clamour in Wales for the divisiveness of new flags and symbols. When I talk to people on my many trips to Ynys Môn and Aberffraw it is evident that there is no clamour for symbols such as the red dragon. Indeed, there would not even be consensus in Wales about whether the red dragon should be used on a new flag—it could be a leek, a fleur de lys or one of a number of other symbols.
	In conclusion, the proposal is eccentric, albeit well-meaning, and it would not add to the unity of our country. Members who, like me, attend citizenship ceremonies are no doubt moved by the sense of unity around the Union flag. The hon. Gentleman's proposal would go in the opposite direction, and would not be in the best interests of the whole of the United Kingdom.

Margaret Hodge: I join other Members in congratulating my hon. Friend the Member for Wrexham (Ian Lucas) on securing the debate. He raises an issue of concern to all our constituents across the UK. As he knows, it is subject to consultation at present. We published our Green Paper in July, and the consultation came to an end on 9 November. We received more than 300 responses, which are being collated as we speak, and we hope to put them on our website shortly. The Government will respond in the new year when we have had time to consider the various responses.
	At present, the Union flag is flown on 16 days in England, and on 18 days in Wales, Scotland and Northern Ireland. We consulted on whether it should be flown all the time, on working days only or on an increased number of fixed days, or whether Departments should be able to choose when to fly it. The consultation covered a range of points. The hon. Member for Romford (Andrew Rosindell) raised the issue of the flags flown at the trooping of the colour. If he writes to me, I shall consider the issue and get back to him.
	The interesting point about tonight's debate is that there are varying views—between Dudley and Sandwell, and between Members. The hon. Member for Peterborough (Mr. Jackson) thought that the proposition by my hon. Friend the Member for Wrexham was expensive and eccentric, whereas the hon. Member for Romford thought we should give it serious consideration. People do not agree.
	I see the debate on the role of the Union flag in the context of our wider debate about Britishness—a debate initiated by my right hon. Friend the Prime Minister—which has resonance across the Chamber and across the country. The debate is relevant for several reasons. We are concerned about the impact of recent changes on our cohesion and sense of identity—whether in relation to issues of terrorism or migration. We are concerned about the loss of civic and political participation. We want to maintain what is commonly described as the social capital aspect of our infrastructure, whereby people feel they are part of a whole and contribute to it.
	It is right that we think about those things and debate them. We have to recognise that action is required locally as well as nationally. The debate is about iconic symbols, of which the flag may be one, and mundane local issues in our communities or in parts of British society. We want people to feel loyalty to their country, but at the same time we understand that we must entirely recognise cultural difference and different communities. We want an inclusive, integrated Britain, but one that accepts diversity and difference.
	That is a difficult concept in a global society, so I hope Members will bear with me while I talk about the British Mini. The Mini is an iconic 1960s British institution, but it was the brainchild of Alex Issigonis, who was born in Turkey to Greek and German parents and came to the UK as a refugee. If we look at the new Mini that has just been designed, we see that it is still essentially British—

Mr. Deputy Speaker: Order. I am sorry to interrupt the right hon. Lady, but this debate has travelled some distance from its original terms. However, her latest remarks have altogether gone far too far. I urge her to talk about what the debate is meant to be about.

Margaret Hodge: My reference was simply to demonstrate the importance of symbols in uniting us, and also in recognising the diversity of what are seen as British institutions, of which the British Mini may be one. It is a complex debate, and I hear what you say—

Mr. Deputy Speaker: Order.

Margaret Hodge: rose—

Mr. Deputy Speaker: Order. When I get to my feet, the right hon. Lady should resume her place. My job is to keep the House in order, even on a relatively relaxed occasion like this. We cannot go too far beyond the scope of the motion, and I urge her not to do so. She can of course develop the subject in all sorts of different ways, but that must be within the terms of the Standing Orders of the House.

Margaret Hodge: Thank you, Mr. Deputy Speaker. However, I hope you will allow me at least the observation that a number of symbols and institutions reflect our Britishness. One of them is the flag. Parliament is an institution of importance and the monarch is another. Iconic institutions such as the British Museum also reflect our Britishness.
	The debate on the flag appears in the wider context of the debate in the White Paper on "The Governance of Britain" in which we talk about such symbols and how they can help to embody a national culture and citizenship. The Union flag is one of the most recognised symbols of unity.

Andrew Rosindell: The Minister has just said that the Union flag is a symbol of unity, and I agree with her. Perhaps she can tell the House whether the borough of Barking and Dagenham flies the Union flag from its civic offices in the same way as the neighbouring borough of Havering does. If not, will she support a campaign to fly the Union flag in Barking and Dagenham as it is flown in Havering?

Margaret Hodge: I genuinely think that that decision ought to be taken by the civic leaders who have responsibility for determining such things locally. It was an interesting part of the hon. Gentleman's contribution, but I am not sure whether dictating what all our democratic institutions across the UK should do, and when and how they should fly the flag, is appropriate for Government to decide. It again goes back to my point about how we define our unity. We define it both locally and nationally. The flag is a national symbol, but I honestly think that how it is used ought to be a matter for local, and not national, determination. His party itself has said that it supports such decentralisation of decision making. He might like to reflect on his view as to whether this Parliament should decide whether all national and local government buildings should stick to a national diktat decided by himself.

Andrew Rosindell: I thank the Minister for being so generous in giving way, and I am sorry, but I want to pursue the point a tiny step further. She is a civic leader in Barking and Dagenham, as I am in Romford, so does she think that the flag should be flown? The neighbouring borough of Havering flies the flag, so does she think that Barking and Dagenham should do the same? What is her personal view?

Margaret Hodge: I hate to say to the hon. Gentleman that I think that this is not an issue for me to dictate to the elected members of the local council, who are responsible for the civic building to which he refers. I genuinely think that it is a decision for them. Although I engage in debate with them on a number of issues, this is one that is quite properly left to them to determine.
	I agree with the hon. Gentleman that in countries such as France and the United States, the national flag is regarded as a source of pride, and in recent years the Union flag has all too often become the preserve of political extremists—a symbol of discord rather than harmony. One of the good reasons for flying the Union flag more often on official buildings could be to reclaim it from those who distort its meaning and use it for political ends.
	In many ways, we have already started to recapture the flag for good, patriotic purposes. I like to reflect on seeing some of our black British athletes draped in the Union flag at the Olympic games in Sydney and Athens, and I look forward to seeing many of them draped in that flag in Beijing next year. I was in a primary school in my constituency last week where the flag was used as a way of explaining some of the history of the Union. That was an interesting way of using the flag in the classroom—and something that had not been dictated by Parliament.
	I welcome the fact that discussion of the Union flag has been a key part of the ongoing conversation about the appropriate role of the state in helping people to shape and define their identity in recent times. Some commentators have said that it is somehow not British to talk about symbols of Britishness, and that that is just not what we do in this country. However, the considerable debate that has been engendered—and brought to the House by my hon. Friend the Member for Wrexham—about the issue of flag flying seems to suggest that that is just not true. It seems just as British to talk about the flag as it is to talk about the weather.
	What we are looking to achieve in the discussion about symbols of our country's identity is something that is both representative and personal—something that allows us immediately to recognise and take pride in the fact that we are part of a larger coherent community, and can find our own place in that community and take an active part in it. For that reason, the opportunity presented by the discussion of the Union flag is timely. The flag is representative of the wider community of the United Kingdom, but it can also be intensely personal—a symbol of our own personal commitment to the values and beliefs of the United Kingdom.
	The proud history of the Union flag shows that it is a potent symbol of the diversity of the United Kingdom. It may be an artificial construction, but let us be honest: its origins do not differ from those of many other countries' flags. There is something in that history—the decision to bring together existing flags in a new Union flag, to which my hon. Friend the Member for Wrexham alluded—that speaks to the task of building cohesive and integrated communities, which sits before us at the moment. The creation of the flag was a moment of pragmatism, but also of vision. That approach speaks as much to long-established British communities as to new communities and new citizens.
	I do not want to prejudge the outcome of the official consultation, but hon. Members will not be surprised to know that there have been a number of suggestions—some no doubt put forward by the hon. Member for Romford—about how we can better recognise and celebrate the origins of the Union flag, and how to use it in different ways. It was suggested that it could be used at citizenship ceremonies or at the birth of children. It needs to be used in a way that ensures that it speaks to everyone, regardless of their background. I hope people will be able to pick up those ideas when the summary of responses is published. I hope the debate will continue, and I would like to see what sort of response it receives.
	The Green Paper introduces the possibility of the wider use of flag flying on Government buildings. Although the flag-flying guidance applies only to UK Government buildings, the impact of the changes is likely to affect other public organisations, because so many of them choose to follow the Government's lead. That includes many local authorities.
	I acknowledge the comments of my hon. Friend the Member for Wrexham and my hon. Friend the Member for Ynys Môn (Albert Owen) on the Union flag, and the need for Wales to be represented. A valid point has been raised. The redesigning of the Union flag was not part of the consultation that we are considering. However, I am aware that a number of respondents have raised the point. I am also aware of the issue being raised in correspondence to the Department in the recent years. It has been suggested, as my hon. Friend the Member for Wrexham said, that the Union flag could be modified by including either the red dragon or the cross of St. David, to represent Wales.
	We are aware that a number of respondents from all over the United Kingdom are not happy flying the Union flag, as they feel that it does not truly represent the United Kingdom. We have already discussed this evening the way in which the flag came about. The Welsh dragon was not included on the Union flag, as the Principality of Wales was already united with England by 1606, when the first Union flag was created. I can assure all hon. Members that the issue of the design of the Union flag will be considered, along with all other points raised, and consideration will be given to whether and how we should take those forward.
	There are implications for redesigning the Union flag to include Wales, including interesting design issues, and the fact that in a diverse country we will never please everyone. As the current Union flag is formed by merging three heraldic crosses representing the three kingdoms of the United Kingdom, the original design was a challenge. Thinking of a new design that would meet everyone's aspirations would be an even greater challenge.
	The Government are keen to make the Union flag a positive symbol of Britishness, reflecting the diversity of our country today and encouraging people to take pride in our national flag. I am committed to ensuring that any changes that we make following the consultation ensure that that is promoted.
	Whether we can trace our history back in these British Isles for 500 years or for only five, the Union flag, as we have all acknowledged in the House tonight, is a powerful symbol of our pragmatic, but principled, decisions on how to give everyone a sense of collective belonging, and at the same time our personal pride in being citizens of the United Kingdom. It is on that basis that I welcome the debate and thank hon. Members for their contributions.
	 Question put and agreed to.
	 Adjourned accordingly at  four minutes to Ten o'clock .